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General NPI Number Information
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NPI Number | 1164703278
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Entity Type | Organization
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Legal Business Name | SUSAN KOESTLER LCSW, INC.
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 1410 AQUARIUS CIR STE 2
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City | OTTAWA
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State | IL
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Zip | 61350-9059
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Country | US
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Telephone | 815-587-4952
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 AQUARIUS CIR STE 2
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City | OTTAWA
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State | IL
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Zip | 61350-9059
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Country | US
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Telephone | 815-587-4952
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SUSAN L KOESTLER
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Credential | LCSW
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Telephone | 815-587-4952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149009180
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License Number State | IL
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