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NPI Code Detail

MEDICARE: SUSAN REYNOLDS LCSW

MEDICARE: SUSAN REYNOLDS LCSW
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
11041C0700XClinical Social Worker149-002541IL

General Provider Information

NPI Number : 1609883875
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN REYNOLDS LCSW
Provider Business Mailing Address
First Line : 1001 ROHLWING RD
Second Line :
City : ELK GROVE VILLAGE
State : IL
Zip : 60007-3217
Country : US
Telephone Number : 847-524-8800
Fax Number : 847-524-8824
Provider Business Practice Location Address
First Line : 1001 ROHLWING RD
Second Line :
City : ELK GROVE VILLAGE
State : IL
Zip : 60007-3217
Country : US
Telephone Number : 847-524-8800
Fax Number : 847-524-8824
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 11/29/2010

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Directions to “ SUSAN REYNOLDS LCSW” Practice Location

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