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General NPI Number Information
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NPI Number | 1780773267
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Entity Type | Individual
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Provider Name | MS. SUSAN SHRIFTER-FIALKOW
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 435 N MICHIGAN AVE SUITE 2800
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City | CHICAGO
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State | IL
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Zip | 60611-4066
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Country | US
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Telephone | 312-245-3120
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Fax | 312-245-3124
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Provider Business Mailing Address
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Address Line | 2435 HAMPTON LN
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City | NORTHBROOK
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State | IL
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Zip | 60062-6942
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Country | US
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Telephone | 312-245-3120
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Fax | 312-245-3124
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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 | 149002946
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License Number State | IL
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