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NPI Code Detail

MEDICARE: MRS. SUSAN HAENDLE BOWKER MSW

MEDICARE:  MRS. SUSAN HAENDLE BOWKER  MSW
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 WorkerIL

General Provider Information

NPI Number : 1760602890
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN HAENDLE BOWKER MSW
Provider Business Mailing Address
First Line : 1103 CLEVELAND ST
Second Line :
City : EVANSTON
State : IL
Zip : 60202-2114
Country : US
Telephone Number : 847-475-2120
Fax Number : 847-491-0616
Provider Business Practice Location Address
First Line : 636 CHURCH ST
Second Line : SUITE 619A
City : EVANSTON
State : IL
Zip : 60201-4586
Country : US
Telephone Number : 847-475-2120
Fax Number : 847-491-0616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. SUSAN HAENDLE BOWKER MSW” Practice Location

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