Provider Demographics
NPI:1073777082
Name:AGRUSS, SUSAN (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:AGRUSS
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LAKE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1028
Mailing Address - Country:US
Mailing Address - Phone:630-686-2019
Mailing Address - Fax:
Practice Address - Street 1:1100 LAKE ST STE 201
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1028
Practice Address - Country:US
Practice Address - Phone:630-686-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL28335101YA0400X
IL1490142131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)