Provider Demographics
NPI:1730320680
Name:GIPPERICH, SUZANNE MICHELE (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MICHELE
Last Name:GIPPERICH
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 ORDAM CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48363-2847
Mailing Address - Country:US
Mailing Address - Phone:248-814-0983
Mailing Address - Fax:
Practice Address - Street 1:1270 DORIS RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2617
Practice Address - Country:US
Practice Address - Phone:248-276-8051
Practice Address - Fax:248-276-9280
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802060029104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker