Provider Information for 1487291027
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SUZANNE GRACE MSW
Sex: Female
NPI: 1487291027
Last Updated: 2019-12-02
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1487291027 | ||||||||
| Enumeration Date | 2019-12-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5904 SEVILLE CIR ORCHARD LAKE, MI 48324-2949 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 5904 SEVILLE CIR ORCHARD LAKE, MI 48324-2949 United States Phone: 248-730-8686 | Fax: | ||||||||
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