Healthcare Provider Details

I. General information

NPI: 1720481583
Provider Name (Legal Business Name): SUAD KATTAN BSWLBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RIVER PLACE DR STE 250
DETROIT MI
48207-5402
US

IV. Provider business mailing address

20825 CASS
FAMINGTON HILLS MI
48335
US

V. Phone/Fax

Practice location:
  • Phone: 313-871-2337
  • Fax: 313-871-6655
Mailing address:
  • Phone: 248-797-0322
  • Fax: 248-476-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6802081552
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: