Healthcare Provider Details

I. General information

NPI: 1962955211
Provider Name (Legal Business Name): SUZANNE OGUNKUNLE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE SHANNON LMSW

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13099 ALLEN RD
SOUTHGATE MI
48195-3099
US

IV. Provider business mailing address

14575 RONNIE LN
LIVONIA MI
48154-5158
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7700
  • Fax:
Mailing address:
  • Phone: 313-926-7276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801109349
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: