MEDICARE: SUSAN M BUSS 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		IL

General Provider Information

NPI Number	:	1912054826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M BUSS LCSW

Provider Business Mailing Address
First Line	:	7620 HARVARD ST
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-2220
Country	:	US
Telephone Number	:	708-366-8363
Fax Number	:	708-366-8212

Provider Business Practice Location Address
First Line	:	7326 HARRISON ST
Second Line	:	SUITE 2A
City	:	FOREST PARK
State	:	IL
Zip	:	60130-2017
Country	:	US
Telephone Number	:	708-642-7020
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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