Provider Demographics
NPI:1487780839
Name:HONECK, SUSAN LORAINE (MSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LORAINE
Last Name:HONECK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7271 KENWARD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9270
Mailing Address - Country:US
Mailing Address - Phone:517-581-6826
Mailing Address - Fax:
Practice Address - Street 1:2301 E MICHIGAN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3700
Practice Address - Country:US
Practice Address - Phone:517-581-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010642991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI80-0-897234-0Medicaid