Provider Information for 1205259686
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Mrs. EWA SUSMAN LCSW, CADC
Sex: Female
NPI: 1205259686
Last Updated: 2023-09-11
Certification Date: 2023-09-11
Certification Date: 2023-09-11
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1205259686 | ||||||||||||
| Enumeration Date | 2014-01-21 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1022 FOREST AVE OAK PARK, IL 60302-1312 United States Phone: 708-704-6951 | Fax: | ||||||||||||
| Primary Practice Address | 1022 FOREST AVE OAK PARK, IL 60302-1312 United States Phone: 708-704-6951 | Fax: | ||||||||||||
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