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NPI Code Detail

MEDICARE: MRS. SUZANNE BRASCHE LCSW

MEDICARE: MRS. SUZANNE BRASCHE 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
11041C0700XClinical Social Worker149000361IL

General Provider Information

NPI Number : 1578520839
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUZANNE BRASCHE LCSW
Provider Business Mailing Address
First Line : 7717 N ORANGE PRAIRIE RD
Second Line :
City : PEORIA
State : IL
Zip : 61615-9323
Country : US
Telephone Number : 309-589-6800
Fax Number : 309-589-6993
Provider Business Practice Location Address
First Line : 7717 N ORANGE PRAIRIE RD
Second Line :
City : PEORIA
State : IL
Zip : 61615-9323
Country : US
Telephone Number : 309-589-6800
Fax Number : 309-589-6993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2006
Last Update Date : 04/03/2013

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