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General NPI Number Information
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NPI Number | 1376758623
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Entity Type | Individual
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Provider Name | SUSAN D SILK PHD
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 26645 W 12 MILE RD STE 104
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City | SOUTHFIELD
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State | MI
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Zip | 48034
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Country | US
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Telephone | 248-350-9890
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Fax |
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Provider Business Mailing Address
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Address Line | 6620 HALYARD
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City | BLOOMFIELD TWP
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State | MI
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Zip | 48301
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Country | US
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Telephone | 248-932-9933
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Fax | 248-932-2831
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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 | 6301003963
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License Number State | MI
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