Provider Demographics
NPI:1437246261
Name:SULENTICH, THERESE CELINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:CELINE
Last Name:SULENTICH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 N. MCKINLEY ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1850
Mailing Address - Country:US
Mailing Address - Phone:847-917-5683
Mailing Address - Fax:847-295-3636
Practice Address - Street 1:725 N. MCKINLEY ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1850
Practice Address - Country:US
Practice Address - Phone:847-917-5683
Practice Address - Fax:847-295-3636
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1671411OtherBLUE CROSS AND BLUE SHIEL
IL35824OtherMAGELLAN HEALTH PROVIDER
IL8662099320OtherUNITED BEHAVIORAL HEALTH
IL594270Medicare ID - Type UnspecifiedCOOK COUNTY
IL1671411OtherBLUE CROSS AND BLUE SHIEL