Provider Demographics
NPI:1720586373
Name:KATLIN, SUZI (LAC,RN)
Entity Type:Individual
Prefix:
First Name:SUZI
Middle Name:
Last Name:KATLIN
Suffix:
Gender:F
Credentials:LAC,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 MIDDLEFORK RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1120
Mailing Address - Country:US
Mailing Address - Phone:847-612-5101
Mailing Address - Fax:
Practice Address - Street 1:2121 MIDDLEFORK RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1120
Practice Address - Country:US
Practice Address - Phone:847-612-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.249206163W00000X
IL198.001374171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse