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General NPI Number Information
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NPI Number | 1265754816
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Entity Type | Organization
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Legal Business Name | SUZANNE S. WALKER LLC
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 51 SHERWOOD TER STE W
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City | LAKE BLUFF
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State | IL
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Zip | 60044-2232
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Country | US
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Telephone | 847-615-5450
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Fax | 847-615-1783
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Provider Business Mailing Address
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Address Line | 51 SHERWOOD TER STE W
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City | LAKE BLUFF
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State | IL
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Zip | 60044-2232
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Country | US
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Telephone | 847-615-5450
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Fax | 847-615-1783
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Authorized Official
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Title or Position | OWNER
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Name | SUZANNE WALKER
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Credential | LCPC, CADC
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Telephone | 847-615-5450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 13728
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180001588
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License Number State | IL
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