MEDICARE: DR. SUZANNE M FRINGS-RAFTERY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1014057	WI
2	103TC0700X	Clinical Psychologist		IL

General Provider Information

NPI Number	:	1598743171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE M FRINGS-RAFTERY PHD

Provider Business Mailing Address
First Line	:	593 CROSSWIND LN
Second Line	:
City	:	LINDENHURST
State	:	IL
Zip	:	60046-6747
Country	:	US
Telephone Number	:	847-356-7333
Fax Number	:	847-356-6027

Provider Business Practice Location Address
First Line	:	2031 E GRAND AVE
Second Line	:	SUITE 300
City	:	LINDENHURST
State	:	IL
Zip	:	60046-9041
Country	:	US
Telephone Number	:	847-356-7333
Fax Number	:	847-356-6027

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. SUZANNE M FRINGS-RAFTERY PHD” Practice Location

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