Individual
MRS. SUSAN ANDREA TACKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP-L
Contact information
Practice address
75 WELLESLEY DR, PLEASANT RIDGE, MI 48069-1242
(248) 854-4824
Mailing address
75 WELLESLEY DR, PLEASANT RIDGE, MI 48069-1242
(248) 854-4824
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101001043
MI
Other
Enumeration date
07/21/2022
Last updated
07/21/2022
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