Provider Demographics
NPI:1639230303
Name:SLOBARD, SUSAN FEDER (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:FEDER
Last Name:SLOBARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:FEDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1021 N MULFORD RD
Mailing Address - Street 2:STE 1
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3877
Mailing Address - Country:US
Mailing Address - Phone:815-399-9700
Mailing Address - Fax:815-394-1401
Practice Address - Street 1:1021 N MULFORD RD
Practice Address - Street 2:STE 1
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3877
Practice Address - Country:US
Practice Address - Phone:815-399-9700
Practice Address - Fax:815-394-1401
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15735812084P0800X, 2084P0804X
FLME1026732084P0800X, 2084P0804X
IL0360682432084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry