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General NPI Number Information
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NPI Number | 1134721178
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Entity Type | Individual
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Provider Name | SUZANNA MARIE WISE PHD
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Gender | Female
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 2200 HUNTINGTON DR N
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City | ALGONQUIN
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State | IL
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Zip | 60102-4419
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Country | US
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Telephone | 630-229-2070
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 HUNTINGTON DR N
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City | ALGONQUIN
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State | IL
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Zip | 60102-4419
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Country | US
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Telephone | 630-229-2070
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.017819
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License Number State | IL
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