Davis, Susan Roberta

Davis, Susan Roberta is an individual health care provider with primary practice located at 2845 Valley View Rd , Gurnee IL 60031-1041. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / School, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Davis, Susan Roberta can be contacted via phone (847) 502-1007.

Contact Information

Primary practice address
2845 Valley View Rd Gurnee IL 60031-1041
Phone: (847) 502-1007
Fax: (815) 301-9025
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 180.007623 Illinois
Behavioral Health & Social Service Providers / School 103TS0200X SS12630298P Illinois
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist 222Q00000X

Profile Details

NPI number 1568418739
LBN Legal business name Davis, Susan Roberta
Credentials LCPC, NCSP, CDS
Entity Individual
Sole proprietor 1 No
Enumeration date May 26th, 2006
Last updated Nov 4th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568418739 NPPES
Illinois Other SS12630298P D.T., SCH PSYCH, EVALS
Illinois Other 180.007623 D.T., SCH PSYCH, EVALS

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