Provider Demographics
NPI:1346364528
Name:SCHREIBER DEVILLEZ, SUSAN KAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAY
Last Name:SCHREIBER DEVILLEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:KAY
Other - Last Name:SCHREIBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:203 BLUFF AVE
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2312
Mailing Address - Country:US
Mailing Address - Phone:847-548-3602
Mailing Address - Fax:847-543-0001
Practice Address - Street 1:11801 SW HIGHWAY
Practice Address - Street 2:SUITE 3CN
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1037
Practice Address - Country:US
Practice Address - Phone:708-361-7435
Practice Address - Fax:847-543-0001
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01673711OtherBLUE CROSS BLUE SHIELD
IL01673711OtherBLUE CROSS BLUE SHIELD