Provider Demographics
NPI:1497245773
Name:DE LOS MONTEROS, SUZANNE (RBT-18-55582)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:DE LOS MONTEROS
Suffix:
Gender:F
Credentials:RBT-18-55582
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:MENARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1841 COURTWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5979
Mailing Address - Country:US
Mailing Address - Phone:708-917-9143
Mailing Address - Fax:
Practice Address - Street 1:1841 COURTWRIGHT DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-5979
Practice Address - Country:US
Practice Address - Phone:708-917-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18-55582106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician