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General NPI Number Information
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NPI Number | 1568780229
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Entity Type | Organization
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Legal Business Name | SUSAN H BOWKER, PROFESSIONAL CORP
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 636 CHURCH ST SUITE 619A
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City | EVANSTON
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State | IL
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Zip | 60201-4508
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Country | US
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Telephone | 847-475-2120
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Fax | 847-491-0616
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Provider Business Mailing Address
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Address Line | 636 CHURCH ST SUITE 619A
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City | EVANSTON
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State | IL
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Zip | 60201-4508
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Country | US
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Telephone | 847-475-2120
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Fax | 847-491-0616
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN HAENDLE BOWKER
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Credential | MSW, LCSW
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Telephone | 847-475-2120
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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 | 149000885
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License Number State | IL
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