Provider Demographics
NPI:1447432752
Name:GARRISON, SUSAN L (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:GARRISON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N 121 COUNTY FARM ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2019
Mailing Address - Country:US
Mailing Address - Phone:630-460-0636
Mailing Address - Fax:
Practice Address - Street 1:1N121 COUNTY FARM RD
Practice Address - Street 2:SUITE 220
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2019
Practice Address - Country:US
Practice Address - Phone:630-460-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0127911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical