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Individual

SUSAN ANNE GANNON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MT-BC

Contact information

Practice address
9357 GENERAL DR, PLYMOUTH, MI 48170-4662
(734) 454-0866
Mailing address
9211 HURON RIVER DR, DEXTER, MI 48130-9611
(734) 426-5634

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
08001
MI

Other

Enumeration date
01/29/2009
Last updated
01/29/2009
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