Healthcare Provider Details

I. General information

NPI: 1881680304
Provider Name (Legal Business Name): SUSAN M. WEDDA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 S DORT HWY SUITE 44
FLINT MI
48507-2093
US

IV. Provider business mailing address

10524 PINE TREE LN
GOODRICH MI
48438-9452
US

V. Phone/Fax

Practice location:
  • Phone: 810-744-3300
  • Fax: 810-744-1090
Mailing address:
  • Phone: 810-636-2311
  • Fax: 810-744-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801000641
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: