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General NPI Number Information
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NPI Number | 1427558121
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Entity Type | Individual
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Provider Name | SUZANNE WYCHOCKI LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 1707 N HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60614-5501
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Country | US
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Telephone | 773-234-4042
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Fax |
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Provider Business Mailing Address
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Address Line | 457 W DEMING PL
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City | CHICAGO
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State | IL
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Zip | 60614-1718
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Country | US
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Telephone | 415-310-1235
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149024046
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.102974
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License Number State | IL
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