Provider Demographics
NPI:1134671746
Name:FREASE, SUSAN ELAIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELAIN
Last Name:FREASE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-1320
Mailing Address - Country:US
Mailing Address - Phone:618-559-7372
Mailing Address - Fax:
Practice Address - Street 1:211 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-1320
Practice Address - Country:US
Practice Address - Phone:618-559-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-30
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0145751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical