1023310828 NPI number — MRS. SUSAN KYLE RADZILOWSKI MSW

Table of content: MRS. SUSAN KYLE RADZILOWSKI MSW (NPI 1023310828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023310828 NPI number — MRS. SUSAN KYLE RADZILOWSKI MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADZILOWSKI
Provider First Name:
SUSAN
Provider Middle Name:
KYLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FITZPATRICK
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023310828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19641 SILVER SPRING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48076-5060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-943-2089
Provider Business Mailing Address Fax Number:
248-618-8072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19641 SILVER SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48076-5060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-943-2089
Provider Business Practice Location Address Fax Number:
248-618-8072
Provider Enumeration Date:
11/30/2010

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: 1041C0700X , with the licence number:  6801019864 , 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)





Copyright © 2007-2025 www.npivalidator.com