Healthcare Provider Details

I. General information

NPI: 1174787527
Provider Name (Legal Business Name): SUSAN JOANNE WARD WARD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 LYONS RD
LYONS MI
48851-9774
US

IV. Provider business mailing address

3800 LYONS RD
LYONS MI
48851-9774
US

V. Phone/Fax

Practice location:
  • Phone: 517-526-2245
  • Fax: 517-647-2122
Mailing address:
  • Phone: 517-526-2245
  • Fax: 517-647-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801078634
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: