Provider Demographics
NPI:1144239047
Name:OLSON, SUSAN M (LCPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:OLSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:STRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LCPC
Mailing Address - Street 1:PO BOX 1509
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60121-1509
Mailing Address - Country:US
Mailing Address - Phone:224-238-4160
Mailing Address - Fax:847-783-0599
Practice Address - Street 1:1121 E MAIN ST
Practice Address - Street 2:SUITE 130
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2205
Practice Address - Country:US
Practice Address - Phone:630-513-5576
Practice Address - Fax:630-513-5657
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001663101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532734OtherBCBS