Provider Demographics
NPI:1598080194
Name:MILLER, SUZANNE K (MED, PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:MED, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 E WALTON ST
Mailing Address - Street 2:UNIT 3502
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5442
Mailing Address - Country:US
Mailing Address - Phone:312-846-1219
Mailing Address - Fax:312-846-1219
Practice Address - Street 1:1500 SKOKIE BLVD
Practice Address - Street 2:SUITE 560
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4121
Practice Address - Country:US
Practice Address - Phone:312-846-6932
Practice Address - Fax:312-846-1219
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical