Provider Demographics
NPI:1447582762
Name:BAKKER, SUSAN HYDE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HYDE
Last Name:BAKKER
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 1:667 E BIG BEAVER RD STE 107
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1430
Mailing Address - Country:US
Mailing Address - Phone:248-250-6620
Mailing Address - Fax:248-250-6629
Practice Address - Street 1:667 E BIG BEAVER RD STE 107
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1430
Practice Address - Country:US
Practice Address - Phone:248-250-6620
Practice Address - Fax:248-250-6629
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010897351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical