Provider Demographics
NPI:1124037916
Name:KRAFT, SUSAN KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:KRAFT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:6898 JAMES STREET
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416-0071
Mailing Address - Country:US
Mailing Address - Phone:810-346-2397
Mailing Address - Fax:
Practice Address - Street 1:14960 E PARK ST
Practice Address - Street 2:
Practice Address - City:CAPAC
Practice Address - State:MI
Practice Address - Zip Code:48014-3177
Practice Address - Country:US
Practice Address - Phone:810-395-4343
Practice Address - Fax:810-395-2985
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010821351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical