Provider Demographics
NPI:1427192889
Name:SIMMONS, SUSANNE ELIZABETH (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:ELIZABETH
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 MARCY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1111
Mailing Address - Country:US
Mailing Address - Phone:847-446-5770
Mailing Address - Fax:847-424-9885
Practice Address - Street 1:723 ELM ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2565
Practice Address - Country:US
Practice Address - Phone:847-446-5770
Practice Address - Fax:847-424-9885
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634658OtherBLUE CROSS AND BLUE SHIEL