Provider Demographics
NPI:1093945362
Name:HASAN PEREZ, SUZAN (MHS CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:SUZAN
Middle Name:
Last Name:HASAN PEREZ
Suffix:
Gender:F
Credentials:MHS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11735 S MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1524
Mailing Address - Country:US
Mailing Address - Phone:708-528-6463
Mailing Address - Fax:
Practice Address - Street 1:11049 S FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1813
Practice Address - Country:US
Practice Address - Phone:708-528-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010136235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist