Healthcare Provider Details

I. General information

NPI: 1477879690
Provider Name (Legal Business Name): SUSAN ELISABETH KEEFAUVER L.M.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA KEEFAUVER L.M.S.W.

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 S STATE ST SUITE 200
ANN ARBOR MI
48104-6184
US

IV. Provider business mailing address

2245 S STATE ST SUITE 200
ANN ARBOR MI
48104-6184
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-0209
  • Fax: 734-769-0224
Mailing address:
  • Phone: 734-769-0209
  • Fax: 734-769-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088601
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: