Healthcare Provider Details

I. General information

NPI: 1336249028
Provider Name (Legal Business Name): SUSAN J FRANK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 JOLLY RD
OKEMOS MI
48864-3514
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-347-6973
  • Fax:
Mailing address:
  • Phone: 517-676-9788
  • Fax: 517-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301009221
License Number StateMI

VIII. Authorized Official

Name: SUSAN J FRANK
Title or Position: OWNER
Credential: PHD
Phone: 517-347-6973