Provider Demographics
NPI:1518550284
Name:ANTONINI, SUSAN JEANNE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEANNE
Last Name:ANTONINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1628
Mailing Address - Country:US
Mailing Address - Phone:847-751-5592
Mailing Address - Fax:
Practice Address - Street 1:1417 TOWER RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1628
Practice Address - Country:US
Practice Address - Phone:847-751-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker