MEDICARE: SUSAN FLYNN-BENDER 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	101Y00000X	Counselor	149006240	IL

General Provider Information

NPI Number	:	1922773555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN FLYNN-BENDER LCSW

Provider Business Mailing Address
First Line	:	55 E JACKSON BLVD STE 1500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-4184
Country	:	US
Telephone Number	:	224-998-5359
Fax Number	:

Provider Business Practice Location Address
First Line	:	4028 DEMPSTER ST
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-2155
Country	:	US
Telephone Number	:	877-381-6538
Fax Number	:

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

Provider Enumeration Date	:	08/16/2021
Last Update Date	:	02/16/2022

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