MEDICARE: SUZANNE GASS LCSW, PC

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	251S00000X	Community/Behavioral Health Agency	149010414	IL

General Provider Information

NPI Number	:	1942473715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUZANNE GASS LCSW, PC

Provider Business Mailing Address
First Line	:	2539 HURD AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1205
Country	:	US
Telephone Number	:	773-490-9643
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 N RAVENSWOOD AVE # 203
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1710
Country	:	US
Telephone Number	:	773-490-9643
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUZANNE GASS
Credential	:
Telephone Number	:	773-490-9643

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	05/18/2016

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