Healthcare Provider Details

I. General information

NPI: 1336003011
Provider Name (Legal Business Name): SUZANA SUZY KOKOTOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5759 N KIMBALL AVE APT 203
CHICAGO IL
60659-4532
US

IV. Provider business mailing address

5759 N KIMBALL AVE APT 203
CHICAGO IL
60659-4532
US

V. Phone/Fax

Practice location:
  • Phone: 312-778-3558
  • Fax:
Mailing address:
  • Phone: 312-778-3558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: