MEDICARE: SUZANNE JOHNSON 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	1041C0700X	Clinical Social Worker	6801032874	MI

General Provider Information

NPI Number	:	1992972046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE JOHNSON LMSW

Provider Business Mailing Address
First Line	:	41800 HAYES RD STE 206
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1876
Country	:	US
Telephone Number	:	586-799-2399
Fax Number	:	586-649-2137

Provider Business Practice Location Address
First Line	:	41800 HAYES RD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1876
Country	:	US
Telephone Number	:	586-799-2399
Fax Number	:	586-649-2137

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

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	11/09/2023

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