Provider Demographics
NPI:1497046726
Name:SUZANNE PACHTMAN
Entity Type:Organization
Organization Name:SUZANNE PACHTMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PACHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MS, CIMI
Authorized Official - Phone:847-849-0476
Mailing Address - Street 1:1404 ELIZABETH LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3159
Mailing Address - Country:US
Mailing Address - Phone:847-849-0476
Mailing Address - Fax:610-643-5087
Practice Address - Street 1:1404 ELIZABETH LN
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3159
Practice Address - Country:US
Practice Address - Phone:847-849-0476
Practice Address - Fax:610-643-5087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016678252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency