Provider Demographics
NPI:1760602890
Name:BOWKER, SUSAN HAENDLE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HAENDLE
Last Name:BOWKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2114
Mailing Address - Country:US
Mailing Address - Phone:847-475-2120
Mailing Address - Fax:847-491-0616
Practice Address - Street 1:636 CHURCH ST
Practice Address - Street 2:SUITE 619A
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4586
Practice Address - Country:US
Practice Address - Phone:847-475-2120
Practice Address - Fax:847-491-0616
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical