Basic Information
| Provider Information | |||||||||
| NPI: | 1053440164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANE | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RN, MA, LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2907 CORAL CT | ||||||||
| Address2: | |||||||||
| City: | TECUMSEH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492869560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174234516 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4650 W US HIGHWAY 223 | ||||||||
| Address2: | |||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492218494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172662588 | ||||||||
| FaxNumber: | 5172660224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401008959 | MI | X | Behavioral Health & Social Service Providers | Counselor | Professional | 163W00000X | 4704196954 | MI | X | Nursing Service Providers | Registered Nurse |
No ID Information.