Healthcare Provider Details

I. General information

NPI: 1710001870
Provider Name (Legal Business Name): SUSAN REED MSN, CSADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 OAK ST
WINNETKA IL
60093-2522
US

IV. Provider business mailing address

1010 LAKE AVE
WILMETTE IL
60091-1764
US

V. Phone/Fax

Practice location:
  • Phone: 847-475-1805
  • Fax: 847-446-6957
Mailing address:
  • Phone: 847-421-3534
  • Fax: 847-251-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number428
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: