Provider Demographics
NPI:1467281071
Name:EDWARDS, SUZANNE MICHELE (CTRS, CDES)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MICHELE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CTRS, CDES
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MICHELE
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:353 COUSINEAU ROAD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9G 1V6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1057
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-1057
Practice Address - Country:US
Practice Address - Phone:616-682-7429
Practice Address - Fax:616-825-6096
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57932225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist