Provider Demographics
NPI:1609167162
Name:IMHOF, SUSAN KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:IMHOF
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 1:100 ORNDORF DR UNIT 66
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-7002
Mailing Address - Country:US
Mailing Address - Phone:810-623-7226
Mailing Address - Fax:810-844-0260
Practice Address - Street 1:8010 GRAND RIVER RD STE 300
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9303
Practice Address - Country:US
Practice Address - Phone:810-772-4262
Practice Address - Fax:810-844-0260
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010920721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP35610054Medicare PIN