MEDICARE: MS. SUSAN BACHARZ GUENTHER L.C.P.C.

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	101Y00000X	Counselor	180.008600	IL
2	101YP2500X	Professional Counselor	180.008600	IL

General Provider Information

NPI Number	:	1497151617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN BACHARZ GUENTHER L.C.P.C.

Provider Business Mailing Address
First Line	:	420 LINDEN AVE
Second Line	:	APT. 204
City	:	WILMETTE
State	:	IL
Zip	:	60091-3608
Country	:	US
Telephone Number	:	224-628-4514
Fax Number	:

Provider Business Practice Location Address
First Line	:	2530 CRAWFORD AVE STE 312
Second Line	:	SUITE 312
City	:	EVANSTON
State	:	IL
Zip	:	60201-4972
Country	:	US
Telephone Number	:	847-595-0603
Fax Number	:

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

Provider Enumeration Date	:	11/16/2014
Last Update Date	:	06/16/2015

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