Provider Demographics
NPI:1023110673
Name:MARKLE, SUSAN D (LMSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:D
Last Name:MARKLE
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 1:275 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444
Mailing Address - Country:US
Mailing Address - Phone:810-387-2355
Mailing Address - Fax:
Practice Address - Street 1:3600 S DORT HWY
Practice Address - Street 2:STE 46
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-767-0350
Practice Address - Fax:810-767-4031
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801077425104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker