Provider Demographics
NPI:1558579912
Name:DIONNE, SUSAN E (MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:DIONNE
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:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0428
Mailing Address - Country:US
Mailing Address - Phone:231-775-6076
Mailing Address - Fax:231-775-0027
Practice Address - Street 1:3287 RACQUET CLUB DR UNIT A
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4702
Practice Address - Country:US
Practice Address - Phone:231-935-0355
Practice Address - Fax:231-935-0360
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801065815104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0897325OtherBLUE CROSS BLUE SHIELD