MEDICARE: MS. SUSAN N EVANS LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	6801078347	MI

General Provider Information

NPI Number	:	1841341088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN N EVANS LMSW

Provider Business Mailing Address
First Line	:	792 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2392
Country	:	US
Telephone Number	:	810-333-2588
Fax Number	:

Provider Business Practice Location Address
First Line	:	792 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2392
Country	:	US
Telephone Number	:	810-333-2588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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