Provider Demographics
NPI:1891904595
Name:SUSAN, PEGGY SUE (MSW, CSW)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:SUE
Last Name:SUSAN
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38206 DELTA ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1707
Mailing Address - Country:US
Mailing Address - Phone:586-419-6518
Mailing Address - Fax:
Practice Address - Street 1:38206 DELTA ST
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1707
Practice Address - Country:US
Practice Address - Phone:586-419-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010683721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical