Provider Demographics
NPI:1043774631
Name:SUSOL, BOGUSLAWA L (RD)
Entity Type:Individual
Prefix:MRS
First Name:BOGUSLAWA
Middle Name:L
Last Name:SUSOL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2149
Mailing Address - Country:US
Mailing Address - Phone:847-239-0019
Mailing Address - Fax:
Practice Address - Street 1:1900 E GOLF RD STE 950H
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5834
Practice Address - Country:US
Practice Address - Phone:872-395-6294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered