Provider Demographics
NPI:1770774507
Name:WINTER, SUE A (MSW)
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:A
Last Name:WINTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 RACQUET CLUB DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4797
Mailing Address - Country:US
Mailing Address - Phone:231-922-2885
Mailing Address - Fax:
Practice Address - Street 1:3180 RACQUET CLUB DR
Practice Address - Street 2:SUITE G
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4797
Practice Address - Country:US
Practice Address - Phone:231-922-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010663211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical