MEDICARE: SUSAN ANN ILYIN APSW, LSW

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	104100000X	Social Worker	150014670	IL
2	104100000X	Social Worker	129919121	WI

General Provider Information

NPI Number	:	1588455315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ANN ILYIN APSW, LSW

Provider Business Mailing Address
First Line	:	N1453 MEADOW RIDGE LN
Second Line	:
City	:	LAKE GENEVA
State	:	WI
Zip	:	53147-4289
Country	:	US
Telephone Number	:	847-977-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	4318 W CRYSTAL LAKE RD STE L
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4250
Country	:	US
Telephone Number	:	815-531-8381
Fax Number	:

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

Provider Enumeration Date	:	05/13/2025
Last Update Date	:	05/22/2025

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