Provider Demographics
NPI:1093390577
Name:FLYNN, SUSAN C (LCPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:FLYNN
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 1:1445 N STATE PKWY # 2703
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-8513
Mailing Address - Country:US
Mailing Address - Phone:847-420-8471
Mailing Address - Fax:
Practice Address - Street 1:466 CENTRAL AVE STE 27
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3031
Practice Address - Country:US
Practice Address - Phone:847-446-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014813101YP2500X
IL178.003719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health