Healthcare Provider Details

I. General information

NPI: 1700438173
Provider Name (Legal Business Name): SUZANNE MARIE HOLLANDSWORTH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 S LANSING ST
MASON MI
48854-1917
US

IV. Provider business mailing address

923 S LANSING ST
MASON MI
48854-1917
US

V. Phone/Fax

Practice location:
  • Phone: 517-930-3071
  • Fax: 517-247-2842
Mailing address:
  • Phone: 517-930-3071
  • Fax: 517-247-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801118083
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: