Provider Demographics
NPI:1770857534
Name:GLYNN, SUSANNE E (PHD, LMSW)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:E
Last Name:GLYNN
Suffix:
Gender:F
Credentials:PHD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635-9333
Mailing Address - Country:US
Mailing Address - Phone:231-352-4945
Mailing Address - Fax:
Practice Address - Street 1:105 FOREST AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9333
Practice Address - Country:US
Practice Address - Phone:231-352-4945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-25
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010834811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical