Provider Demographics
NPI:1598878282
Name:MCCLANAHAN, SUSAN FOTI (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:FOTI
Last Name:MCCLANAHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N. MICHIGAN AVE
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-3994
Mailing Address - Country:US
Mailing Address - Phone:312-337-6064
Mailing Address - Fax:847-729-5462
Practice Address - Street 1:333 E ONTARIO ST APT 4401B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4895
Practice Address - Country:US
Practice Address - Phone:312-337-6064
Practice Address - Fax:847-729-5462
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0081645190OtherBC/BS