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General NPI Number Information
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NPI Number | 1255059424
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Entity Type | Organization
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Legal Business Name | SUSAN IMHOF LLC
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 8010 GRAND RIVER RD STE 300
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City | BRIGHTON
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State | MI
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Zip | 48114-9303
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Country | US
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Telephone | 810-772-4262
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Fax |
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Provider Business Mailing Address
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Address Line | 8493 SADDLEWOOD DR
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City | BRIGHTON
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State | MI
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Zip | 48116-5204
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Country | US
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Telephone | 810-623-7226
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN IMHOF
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Credential | LMSW
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Telephone | 810-623-7226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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