Provider Demographics
NPI:1689208241
Name:PLEZIA, SUSAN L (MA LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:PLEZIA
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 BLACKSTONE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-2665
Mailing Address - Country:US
Mailing Address - Phone:217-220-5376
Mailing Address - Fax:
Practice Address - Street 1:706 OGLESBY AVE STE 111
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4624
Practice Address - Country:US
Practice Address - Phone:309-585-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011797101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty