Healthcare Provider Details

I. General information

NPI: 1801467576
Provider Name (Legal Business Name): JENNIFER SUASTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S RIVER ST
AURORA IL
60506-5185
US

IV. Provider business mailing address

70 S RIVER ST
AURORA IL
60506-5185
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-2662
  • Fax:
Mailing address:
  • Phone: 630-844-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150113848
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149030129
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: