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General NPI Number Information
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NPI Number | 1699144063
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Entity Type | Individual
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Provider Name | SUSAN BURRILL LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 300 S 28TH ST
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City | BATTLE CREEK
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State | MI
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Zip | 49015-2854
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Country | US
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Telephone | 269-565-3904
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Fax | 269-565-3928
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Provider Business Mailing Address
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Address Line | 190 E MICHIGAN AVE
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City | BATTLE CREEK
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State | MI
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Zip | 49014-4005
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Country | US
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Telephone |
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 680103301
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License Number State | MI
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