Healthcare Provider Details

I. General information

NPI: 1760698260
Provider Name (Legal Business Name): SUSAN MARY YOUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9263 DEE RD
DES PLAINES IL
60016-4227
US

IV. Provider business mailing address

9263 DEE RD
DES PLAINES IL
60016-4227
US

V. Phone/Fax

Practice location:
  • Phone: 847-296-2614
  • Fax: 847-789-8597
Mailing address:
  • Phone: 847-296-2614
  • Fax: 847-789-8597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number041-230219
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.000713
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: