Provider Demographics
NPI:1053440164
Name:KANE, SUE ANN (RN, MA, LLPC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:KANE
Suffix:
Gender:F
Credentials:RN, MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 CORAL CT
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-9560
Mailing Address - Country:US
Mailing Address - Phone:517-423-4516
Mailing Address - Fax:
Practice Address - Street 1:4650 W US HIGHWAY 223
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8494
Practice Address - Country:US
Practice Address - Phone:517-266-2588
Practice Address - Fax:517-266-0224
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008959101YP2500X
MI4704196954163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered163W00000XNursing Service ProvidersRegistered Nurse