Provider Demographics
NPI:1962955211
Name:OGUNKUNLE, SUZANNE (LLMSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:OGUNKUNLE
Suffix:
Gender:
Credentials:LLMSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:14575 RONNIE LN
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5158
Mailing Address - Country:US
Mailing Address - Phone:313-926-7276
Mailing Address - Fax:
Practice Address - Street 1:13099 ALLEN RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3099
Practice Address - Country:US
Practice Address - Phone:734-785-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011093491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical