Provider Demographics
NPI:1588713382
Name:WEAVER, SUSAN LYN (LCSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:471 W SOUTH ST
Mailing Address - Street 2:STE. 41C
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4678
Mailing Address - Country:US
Mailing Address - Phone:269-384-3212
Mailing Address - Fax:269-384-2860
Practice Address - Street 1:471 W SOUTH ST
Practice Address - Street 2:STE. 41C
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4678
Practice Address - Country:US
Practice Address - Phone:269-384-3212
Practice Address - Fax:269-384-2860
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010070971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical