Provider Demographics
NPI:1225429327
Name:BATES, SUZANNE (LSW, CADC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:LSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8180 FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:IL
Mailing Address - Zip Code:61024-9719
Mailing Address - Country:US
Mailing Address - Phone:815-871-6381
Mailing Address - Fax:
Practice Address - Street 1:11447 2ND ST STE 9B
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-9522
Practice Address - Country:US
Practice Address - Phone:815-601-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30760101YA0400X
IL150.014983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health