Provider Demographics
NPI:1225110208
Name:TAYLOR, SUZANNE SHIFFLETT (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:SHIFFLETT
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9460 S SAGINAW ST
Mailing Address - Street 2:STE D
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8207
Mailing Address - Country:US
Mailing Address - Phone:810-695-9466
Mailing Address - Fax:810-695-4311
Practice Address - Street 1:9460 S SAGINAW ST
Practice Address - Street 2:STE D
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8207
Practice Address - Country:US
Practice Address - Phone:810-695-9466
Practice Address - Fax:810-695-4311
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801065486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008984240OtherBCBS
MI121805Medicare UPIN
MI1010704Medicare UPIN
MIN98140001Medicare ID - Type UnspecifiedMEDICARE