Provider Demographics
NPI:1346374261
Name:PRIEBE, SUZANNE JEANETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:JEANETTE
Last Name:PRIEBE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:JEANETTE
Other - Last Name:HESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:7968 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305
Mailing Address - Country:US
Mailing Address - Phone:847-406-6359
Mailing Address - Fax:
Practice Address - Street 1:101 N. MARION ST.
Practice Address - Street 2:SUITE 201
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:708-232-0925
Practice Address - Fax:847-446-6957
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007054103TC0700X
IL071.00754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical