Provider Demographics
NPI:1477529287
Name:BENNETT, SUSAN ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 N PLUM GROVE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5144
Mailing Address - Country:US
Mailing Address - Phone:847-413-9700
Mailing Address - Fax:847-413-1701
Practice Address - Street 1:919 N PLUM GROVE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5144
Practice Address - Country:US
Practice Address - Phone:847-413-9700
Practice Address - Fax:847-413-1701
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005508103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
210811Medicare ID - Type Unspecified
K16195Medicare UPIN