Susan Beth Wank

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

6361003480 Issued in MI

Practice address

30400 Telegraph Rd
Bingham Farms, MI 48025-4537

Phone

(248) 579-9345

NPI assigned

Jun 14, 2022

Last updated

Jun 14, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1417687377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30400 TELEGRAPH RD",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254537",
            "telephone_number": "248-579-9345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30400 TELEGRAPH RD",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254537",
            "telephone_number": "248-579-9345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANK",
        "first_name": "SUSAN",
        "middle_name": "BETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-14",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MI",
            "license": "6361003480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Child & Adolescent Psychologist in Bingham Farms, MI
• Providers in Bingham Farms, MI by specialty
• Clinical Child & Adolescent Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.