Provider Demographics
NPI:1417098021
Name:PATTISON, SUSAN SHERRILL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SHERRILL
Last Name:PATTISON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-2303
Mailing Address - Country:US
Mailing Address - Phone:269-651-4960
Mailing Address - Fax:
Practice Address - Street 1:103 S 4TH ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1819
Practice Address - Country:US
Practice Address - Phone:269-651-3902
Practice Address - Fax:269-659-4874
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010448103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical