Healthcare Provider Details

I. General information

NPI: 1366814758
Provider Name (Legal Business Name): SUSAN O'GRADY PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN SKEPPSTROM

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MAIN ST
PARK RIDGE IL
60068-4060
US

IV. Provider business mailing address

32 MAIN ST
PARK RIDGE IL
60068-4060
US

V. Phone/Fax

Practice location:
  • Phone: 847-823-4444
  • Fax: 847-823-4456
Mailing address:
  • Phone: 847-823-4444
  • Fax: 847-823-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178009626
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009536
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: