Healthcare Provider Details

I. General information

NPI: 1083297816
Provider Name (Legal Business Name): SUSAN MARIE ANEWALT LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 SKOKIE BLVD STE 260
NORTHBROOK IL
60062-4019
US

IV. Provider business mailing address

899 SKOKIE BLVD STE 260
NORTHBROOK IL
60062-4019
US

V. Phone/Fax

Practice location:
  • Phone: 630-974-6602
  • Fax: 630-487-2411
Mailing address:
  • Phone: 630-974-6602
  • Fax: 630-487-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.017824
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: