Provider Demographics
NPI:1417008970
Name:HARRIS, SUSAN RICKELS (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RICKELS
Last Name:HARRIS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8780 W GOLF RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5602
Mailing Address - Country:US
Mailing Address - Phone:847-674-5585
Mailing Address - Fax:847-824-7453
Practice Address - Street 1:8780 W GOLF RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5602
Practice Address - Country:US
Practice Address - Phone:847-674-5585
Practice Address - Fax:847-824-7453
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000041231H00000X
IL147.001326231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P20170006OtherMEDICARE PTAN