Provider Demographics
NPI:1528397759
Name:LITOFF, SUSAN G
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:G
Last Name:LITOFF
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 1:2225 WESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2647
Mailing Address - Country:US
Mailing Address - Phone:847-630-6280
Mailing Address - Fax:847-733-1174
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 2504
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:312-236-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCERTIFICATION #65101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL310-7875-0825OtherDRIVER'S LICENSE