Provider Demographics
NPI:1053454439
Name:SUSS, SUZANNE RUTH (MA CCC A)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:RUTH
Last Name:SUSS
Suffix:
Gender:F
Credentials:MA CCC A
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:RUTH
Other - Last Name:SUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC A
Mailing Address - Street 1:2001 N CLYBOURN AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4036
Mailing Address - Country:US
Mailing Address - Phone:773-248-9121
Mailing Address - Fax:773-248-9176
Practice Address - Street 1:2001 N CLYBOURN AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4036
Practice Address - Country:US
Practice Address - Phone:773-248-9121
Practice Address - Fax:773-248-9176
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
12094543OtherASHA
ILK25485Medicare ID - Type Unspecified