Provider Demographics
NPI:1780042978
Name:HYSSONG, EMILY LAURA (LMSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LAURA
Last Name:HYSSONG
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 1:3812 BELLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2852
Mailing Address - Country:US
Mailing Address - Phone:313-820-8089
Mailing Address - Fax:
Practice Address - Street 1:3812 BELLA VISTA DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2852
Practice Address - Country:US
Practice Address - Phone:313-820-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2023-09-06
Deactivation Date:2018-10-01
Deactivation Code:
Reactivation Date:2023-08-31
Provider Licenses
StateLicense IDTaxonomies
MI68010959871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical