Provider Demographics
NPI:1346214442
Name:YELLEN, SUZANNE BIRON (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:BIRON
Last Name:YELLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7084
Mailing Address - Country:US
Mailing Address - Phone:847-922-4080
Mailing Address - Fax:847-998-7427
Practice Address - Street 1:3633 W LAKE AVE
Practice Address - Street 2:SUITE #404
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5805
Practice Address - Country:US
Practice Address - Phone:847-998-7425
Practice Address - Fax:847-998-7427
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001673577OtherBLUE CROSS BLUE SHIELD
IL0001673577OtherBLUE CROSS BLUE SHIELD
IL963310Medicare PIN