Provider Demographics
NPI:1174644041
Name:REITSMA, SUSAN M
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:REITSMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:ROGGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:44 TOWNCENTER
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60466-2800
Mailing Address - Country:US
Mailing Address - Phone:708-534-0800
Mailing Address - Fax:
Practice Address - Street 1:501 ELLA AVENUE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60433-2799
Practice Address - Country:US
Practice Address - Phone:815-727-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2023-09-14
Deactivation Date:2013-05-01
Deactivation Code:
Reactivation Date:2023-09-14
Provider Licenses
StateLicense IDTaxonomies
IL180000782101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional