Provider Demographics
NPI:1205040193
Name:ARENKILL, SUSAN M (NCLMTRM)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:ARENKILL
Suffix:
Gender:F
Credentials:NCLMTRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E. WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60506
Mailing Address - Country:US
Mailing Address - Phone:630-235-5712
Mailing Address - Fax:
Practice Address - Street 1:5 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8622
Practice Address - Country:US
Practice Address - Phone:630-235-5712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist