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General NPI Number Information
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NPI Number | 1992907646
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Entity Type | Individual
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Provider Name | SUSAN MARIE HANSEN L.L.P.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 19291 NORTHLINE RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-2220
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Country | US
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Telephone | 734-287-1500
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Fax | 734-287-1660
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Provider Business Mailing Address
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Address Line | 3465 RICHARD ST
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City | ANN ARBOR
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State | MI
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Zip | 48104-5246
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Country | US
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Telephone | 734-417-8397
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301009726
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License Number State | MI
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