MEDICARE: MRS. SUSAN R MAGEE LCPC, CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	20331	IL
2	101YP2500X	Professional Counselor	180.005019	IL

General Provider Information

NPI Number	:	1447435128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN R MAGEE LCPC, CADC

Provider Business Mailing Address
First Line	:	PO BOX 8631
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-7018
Country	:	US
Telephone Number	:	847-826-1569
Fax Number	:

Provider Business Practice Location Address
First Line	:	34930 N HIGHWAY 45
Second Line	:	SUITE 101
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-7537
Country	:	US
Telephone Number	:	847-826-1569
Fax Number	:

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

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	01/05/2011

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