Provider Demographics
NPI:1477545747
Name:DEGROOT, SUSAN MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:DEGROOT
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 1:205 S FRONT ST STE D
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4629
Mailing Address - Country:US
Mailing Address - Phone:906-235-1800
Mailing Address - Fax:906-273-1050
Practice Address - Street 1:205 S FRONT ST STE D
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4629
Practice Address - Country:US
Practice Address - Phone:906-235-1800
Practice Address - Fax:906-273-1050
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI68010134461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI164009OtherVALUE OPTIONS PROVIDER
MI8008951700OtherMICHIGAN BLUE CROSS
MI800011368OtherPALMETO GBA- RAILROAD RET
MI800011368OtherPALMETO GBA- RAILROAD RET