Provider Demographics
NPI:1083683791
Name:PEROUTKA, SUZANNE (MS, LCPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:PEROUTKA
Suffix:
Gender:F
Credentials:MS, LCPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 S WEBSTER ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 S WEBSTER ST
Practice Address - Street 2:SUITE 320
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5356
Practice Address - Country:US
Practice Address - Phone:630-305-5702
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232501OtherBCBSIL