Provider Demographics
NPI:1508984568
Name:TAYLOR, SUSAN LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:LYNN
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:28175 HAGGERTY ROAD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-4322
Mailing Address - Country:US
Mailing Address - Phone:734-646-5327
Mailing Address - Fax:
Practice Address - Street 1:28175 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2903
Practice Address - Country:US
Practice Address - Phone:734-646-5327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010826311041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM12937OtherMEDICARE PTAN NUMBER