Provider Demographics
NPI:1538491345
Name:CHRISTOPHERSON, SUSAN Y (AUD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:Y
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:P
Other - Last Name:YOPCHICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:25 N WINFIELD RD., #519
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190
Mailing Address - Country:US
Mailing Address - Phone:630-668-2180
Mailing Address - Fax:
Practice Address - Street 1:0N025 WINFIELD RD
Practice Address - Street 2:SUITE 519
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1237
Practice Address - Country:US
Practice Address - Phone:630-668-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-001333231H00000X
231HA2400X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
771980002Medicare PIN