Provider Demographics
NPI:1679693329
Name:GRYGORCEWICZ, RYANNE LEIGH (LMSW)
Entity type:Individual
Prefix:MS
First Name:RYANNE
Middle Name:LEIGH
Last Name:GRYGORCEWICZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:RYANNE
Other - Middle Name:LEIGH
Other - Last Name:GOETHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2884 HARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-1508
Mailing Address - Country:US
Mailing Address - Phone:734-755-1117
Mailing Address - Fax:
Practice Address - Street 1:2884 HARWOOD DR
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-1508
Practice Address - Country:US
Practice Address - Phone:734-755-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010877671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical