Healthcare Provider Details

I. General information

NPI: 1760070197
Provider Name (Legal Business Name): SUSAN BETH BOYD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 W WILSON AVE APT 2
CHICAGO IL
60640-8538
US

IV. Provider business mailing address

1633 W WILSON AVE APT 2
CHICAGO IL
60640-8538
US

V. Phone/Fax

Practice location:
  • Phone: 224-548-4375
  • Fax:
Mailing address:
  • Phone: 224-548-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149008826
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149008826
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: