MEDICARE: SUSAN E PANITCH M.A.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101Y00000X	Counselor	IL
2	101YM0800X	Mental Health Counselor	IL
3	101YP2500X	Professional Counselor	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4926888	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1952372724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN E PANITCH M.A.

Provider Business Mailing Address
First Line	:	655 ROCKLAND RD
Second Line	:	SUITE 210
City	:	LAKE BLUFF
State	:	IL
Zip	:	60044-1780
Country	:	US
Telephone Number	:	847-615-9445
Fax Number	:	847-735-0815

Provider Business Practice Location Address
First Line	:	655 ROCKLAND RD
Second Line	:	SUITE 210
City	:	LAKE BLUFF
State	:	IL
Zip	:	60044-1782
Country	:	US
Telephone Number	:	847-615-9445
Fax Number	:	847-735-0815

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	09/11/2025

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