Basic Information
Provider Information
NPI: 1972978807
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANKER
FirstName: SUSAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8898 COMMERCE RD STE 3A
Address2:  
City: COMMERCE TOWNSHIP
State: MI
PostalCode: 483824485
CountryCode: US
TelephoneNumber: 2483632850
FaxNumber: 7342075326
Practice Location
Address1: 8898 COMMERCE RD STE 3A
Address2:  
City: COMMERCE TOWNSHIP
State: MI
PostalCode: 483824485
CountryCode: US
TelephoneNumber: 2483632850
FaxNumber: 7342075326
Other Information
ProviderEnumerationDate: 12/03/2015
LastUpdateDate: 12/03/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X6801087338MIY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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