MEDICARE: SUSAN MARY STRANGE LCSW

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	1041C0700X	Clinical Social Worker	149001275	IL

General Provider Information

NPI Number	:	1568688240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARY STRANGE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 306
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60065-0306
Country	:	US
Telephone Number	:	847-714-1817
Fax Number	:	847-714-1817

Provider Business Practice Location Address
First Line	:	1 S WACKER DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-4614
Country	:	US
Telephone Number	:	847-714-1817
Fax Number	:	847-714-1817

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	06/04/2014

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Directions to “ SUSAN MARY STRANGE LCSW” Practice Location

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