Provider Demographics
NPI:1225245756
Name:SANDHOLM, SUSAN E (MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:SANDHOLM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 GREEN BAY RD
Mailing Address - Street 2:APT 402
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3359
Mailing Address - Country:US
Mailing Address - Phone:847-920-1465
Mailing Address - Fax:
Practice Address - Street 1:3200 GRANT ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1903
Practice Address - Country:US
Practice Address - Phone:847-866-1645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical