Provider Demographics
NPI:1174162457
Name:HASSE, SUZANNE L (MED, BCBA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:HASSE
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 SPRINGFIELD CT
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1030
Mailing Address - Country:US
Mailing Address - Phone:248-962-8217
Mailing Address - Fax:
Practice Address - Street 1:100 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2465
Practice Address - Country:US
Practice Address - Phone:810-534-6152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401001029103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst