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General NPI Number Information
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NPI Number | 1841743655
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Entity Type | Individual
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Provider Name | SUSANA MICHELLE DE LEON LLMSW
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Gender | Female
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 550 CHERRY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503
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Country | US
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Telephone | 616-235-7272
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Fax | 616-235-0739
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Provider Business Mailing Address
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Address Line | 100 CHERRY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4526
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Country | US
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Telephone | 616-965-8200
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Fax | 616-940-5366
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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