Provider Demographics
NPI:1801983234
Name:PAVLIK, SUSAN D (LLP LIMITED LICENSE)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:D
Last Name:PAVLIK
Suffix:
Gender:F
Credentials:LLP LIMITED LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:45441
Mailing Address - Country:US
Mailing Address - Phone:231-728-6572
Mailing Address - Fax:
Practice Address - Street 1:1528 SIXTH ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:45441
Practice Address - Country:US
Practice Address - Phone:231-728-6572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010813103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist