Provider Demographics
NPI:1720537566
Name:EIMER, SU JIN (LCSW)
Entity Type:Individual
Prefix:
First Name:SU
Middle Name:JIN
Last Name:EIMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:JEONG
Other - Last Name:EIMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5627 W EASTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3307
Mailing Address - Country:US
Mailing Address - Phone:773-590-2661
Mailing Address - Fax:773-728-4751
Practice Address - Street 1:5627 W EASTWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3307
Practice Address - Country:US
Practice Address - Phone:773-590-2661
Practice Address - Fax:773-728-4751
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.013499104100000X
IL149.0188281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker