Provider Demographics
NPI:1225167927
Name:REYNOLDS, SUZANNE JEROME (MSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:JEROME
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:JEROME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3222 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:MI
Mailing Address - Zip Code:49012-9247
Mailing Address - Country:US
Mailing Address - Phone:269-808-5220
Mailing Address - Fax:
Practice Address - Street 1:5500 ARMSTRONG RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-1014
Practice Address - Country:US
Practice Address - Phone:269-808-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010806201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical