Provider Demographics
NPI:1700939675
Name:PRINZING KLUSINSKE, SUSAN (CSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:PRINZING KLUSINSKE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6204
Practice Address - Street 1:1210 W SAGINAW ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1927
Practice Address - Country:US
Practice Address - Phone:517-364-7575
Practice Address - Fax:517-364-7560
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801059856104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008956980OtherINDIVIDUAL BCBS PIN #
MIN23790004Medicare PIN
P43460Medicare UPIN