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General NPI Number Information
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NPI Number | 1295946366
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Entity Type | Individual
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Provider Name | SUSAN WISEHART M.S., NCSP, LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 25671 HILLVIEW CT
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City | MUNDELEIN
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State | IL
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Zip | 60060-9436
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Country | US
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Telephone | 847-438-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 329 WOODVIEW RD APT D
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City | LAKE BARRINGTON
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State | IL
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Zip | 60010-1775
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Country | US
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Telephone | 847-438-7878
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 16600159
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License Number State | IL
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