1265532998 NPI number — MRS. SUSAN HAWKINS BOYER MA LPC

Table of content: MRS. SUSAN HAWKINS BOYER MA LPC (NPI 1265532998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265532998 NPI number — MRS. SUSAN HAWKINS BOYER MA LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYER
Provider First Name:
SUSAN
Provider Middle Name:
HAWKINS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265532998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 CHARLES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-613-9090
Provider Business Mailing Address Fax Number:
248-601-9991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1460 WALTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48309-1768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-613-9090
Provider Business Practice Location Address Fax Number:
248-601-9991
Provider Enumeration Date:
09/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401006238 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1201000446 . This is a "CERT # ALLIED HEALTH" identifier . This identifiers is of the category "OTHER".