Healthcare Provider Details

I. General information

NPI: 1013537935
Provider Name (Legal Business Name): SUONG ANH NGUYEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUE ANH NGUYEN LMSW

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 W CLARK RD APT J203
DEWITT MI
48820-9430
US

IV. Provider business mailing address

3505 W CLARK RD APT J203
DEWITT MI
48820-9430
US

V. Phone/Fax

Practice location:
  • Phone: 616-635-8457
  • Fax:
Mailing address:
  • Phone: 616-635-8457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119165
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: