Provider Demographics
NPI:1427558121
Name:WYCHOCKI, SUZANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:WYCHOCKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 W DEMING PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1718
Mailing Address - Country:US
Mailing Address - Phone:415-310-1235
Mailing Address - Fax:
Practice Address - Street 1:1707 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5501
Practice Address - Country:US
Practice Address - Phone:773-234-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490240461041C0700X
IL150.102974104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty