Provider Demographics
NPI:1770729287
Name:HILDEBRANDT BURCH, SUSAN (LMSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:HILDEBRANDT BURCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:LEIGH
Other - Last Name:HILDEBRANDT BURCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:708 W HURON ST
Mailing Address - Street 2:#6
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4200
Mailing Address - Country:US
Mailing Address - Phone:734-741-8880
Mailing Address - Fax:
Practice Address - Street 1:708 W HURON ST
Practice Address - Street 2:#6
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-4200
Practice Address - Country:US
Practice Address - Phone:734-741-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI680100336401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical