Provider Demographics
NPI:1689163974
Name:MULLAN, SUZANNE M (DPT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:MULLAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:YASSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:1117 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2827
Practice Address - Country:US
Practice Address - Phone:630-724-0977
Practice Address - Fax:630-724-0978
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist