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General NPI Number Information
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NPI Number | 1780975011
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Entity Type | Individual
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Provider Name | SUSAN TRUDEAU LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 4822 N BROADWAY ST 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60640-3604
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Country | US
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Telephone | 773-433-1253
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Fax | 773-271-8810
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Provider Business Mailing Address
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Address Line | 3727 N MARSHFIELD AVE #3
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City | CHICAGO
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State | IL
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Zip | 60613-3621
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Country | US
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Telephone | 773-404-2577
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Fax | 773-271-8810
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12732
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.006965
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License Number State | IL
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