Healthcare Provider Details

I. General information

NPI: 1851729404
Provider Name (Legal Business Name): SUSAN KYUNG BUEHLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S. PAULINA STREET SUITE 742
CHICAGO IL
60612
US

IV. Provider business mailing address

701 S. PAULINA STREET SUITE 742
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-7818
  • Fax:
Mailing address:
  • Phone: 312-942-7818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008665
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: