Provider Demographics
NPI:1093872897
Name:BEDNAR, SUSAN GAIL (MSW, LCSW, CDVC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GAIL
Last Name:BEDNAR
Suffix:
Gender:F
Credentials:MSW, LCSW, CDVC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 N 500 EAST RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-8245
Mailing Address - Country:US
Mailing Address - Phone:217-762-3516
Mailing Address - Fax:
Practice Address - Street 1:6 DUNLAP CT
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9501
Practice Address - Country:US
Practice Address - Phone:217-352-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical