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General NPI Number Information
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NPI Number | 1144555319
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Entity Type | Individual
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Provider Name | SUSAN R WHITE M.S., LLP
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Gender | Female
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Dates
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Enumeration Date | 10/06/2009
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Last Update Date | 10/06/2009
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Provider Practice Location Address
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Address Line | 8303 PLATT RD
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City | SALINE
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State | MI
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Zip | 48176-9773
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Country | US
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Telephone | 734-295-4435
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Fax | 734-295-4898
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Provider Business Mailing Address
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Address Line | 1411 WAGON WHEEL RD
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City | CANTON
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State | MI
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Zip | 48188-1158
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Country | US
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Telephone | 734-295-4435
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Fax | 734-295-4898
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301008069
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License Number State | MI
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