Provider Demographics
NPI:1336727551
Name:DICE, SUSAN (LMSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DICE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BOEVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4503 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-8725
Mailing Address - Country:US
Mailing Address - Phone:616-836-0036
Mailing Address - Fax:
Practice Address - Street 1:4503 LEONARD ST
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-8725
Practice Address - Country:US
Practice Address - Phone:616-836-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011113381041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical