MEDICARE: MS. SUSANNE M SWISHER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	071-004871	IL

General Provider Information

NPI Number	:	1114936663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSANNE M SWISHER PH.D.

Provider Business Mailing Address
First Line	:	326 OXFORD RD
Second Line	:
City	:	KENILWORTH
State	:	IL
Zip	:	60043-1167
Country	:	US
Telephone Number	:	847-251-5489
Fax Number	:	847-251-6666

Provider Business Practice Location Address
First Line	:	3545 LAKE AVE
Second Line	:	SUITE #200
City	:	WILMETTE
State	:	IL
Zip	:	60091-1058
Country	:	US
Telephone Number	:	847-251-7350
Fax Number	:	847-853-2600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/28/2011

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