Healthcare Provider Details

I. General information

NPI: 1205923281
Provider Name (Legal Business Name): SUSAN MARIE WOTRING LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3694 CLARKSTON RD SUITE D
CLARKSTON MI
48348-5213
US

IV. Provider business mailing address

7388 PERRYVILLE RD
HOLLY MI
48442-9431
US

V. Phone/Fax

Practice location:
  • Phone: 248-693-8880
  • Fax: 248-391-7478
Mailing address:
  • Phone: 248-693-8880
  • Fax: 248-391-7478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801014953
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: