Healthcare Provider Details

I. General information

NPI: 1124037916
Provider Name (Legal Business Name): SUSAN KAY KRAFT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14960 E PARK ST
CAPAC MI
48014-3177
US

IV. Provider business mailing address

PO BOX 71 6898 JAMES STREET
BROWN CITY MI
48416-0071
US

V. Phone/Fax

Practice location:
  • Phone: 810-395-4343
  • Fax: 810-395-2985
Mailing address:
  • Phone: 810-346-2397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801082135
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: