Provider Demographics
NPI:1972853570
Name:RISI, SUSAN ALISON (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ALISON
Last Name:RISI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4498
Mailing Address - Country:US
Mailing Address - Phone:734-846-9620
Mailing Address - Fax:
Practice Address - Street 1:1565 EASTOVER PL
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6316
Practice Address - Country:US
Practice Address - Phone:734-741-8844
Practice Address - Fax:734-741-9038
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012532103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent