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Individual
SUSAN WILSON
Active
Individual
SUSAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW, ACSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801068911
MI
1041S0200X
School Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801068911
LARA
MI
Enumeration date
11/01/2017
Last updated
11/01/2017
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