Blackburn, Susan Diane
Blackburn, Susan Diane is an individual health care provider with primary practice located at 2006 Holton Rd , North Muskegon MI 49445-1505. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Blackburn, Susan Diane can be contacted via phone (231) 672-3333.Contact Information
Primary practice address
2006 Holton Rd
North Muskegon MI 49445-1505
Phone: (231) 672-3333
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 6801079604 | Michigan |
Profile Details
| NPI number | 1649512484 |
|---|---|
| LBN Legal business name | Blackburn, Susan Diane |
| Credentials | LMSW |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 19th, 2013 |
| Last updated | Aug 19th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1649512484 | NPPES |
| Michigan | MEDICAID | 1649512484 |
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