Provider Demographics
NPI:1053075564
Name:STEINKE, SUSAN (LCPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:STEINKE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 N WASHTENAW AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2928
Mailing Address - Country:US
Mailing Address - Phone:864-414-6431
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 424
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3844
Practice Address - Country:US
Practice Address - Phone:312-279-9981
Practice Address - Fax:312-279-9981
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013872101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180013872OtherSTATE OF ILLINOIS