Provider Demographics
NPI:1497704340
Name:RODGERS, SUZANNE ELIZABETH (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:RODGERS
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 1:725 S ADAMS RD
Mailing Address - Street 2:SUITE L-163
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6902
Mailing Address - Country:US
Mailing Address - Phone:248-648-9021
Mailing Address - Fax:313-865-6614
Practice Address - Street 1:725 S ADAMS RD
Practice Address - Street 2:SUITE L-163
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6902
Practice Address - Country:US
Practice Address - Phone:248-648-9021
Practice Address - Fax:313-865-6614
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010588271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI80-0-89-1769-0OtherBLUE CROSS PIN NUMBER
MIOM39360Medicare PIN