Provider Demographics
NPI:1760698260
Name:YOUNG, SUSAN MARY (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9263 DEE RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4227
Mailing Address - Country:US
Mailing Address - Phone:847-296-2614
Mailing Address - Fax:847-789-8597
Practice Address - Street 1:9263 DEE RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4227
Practice Address - Country:US
Practice Address - Phone:847-296-2614
Practice Address - Fax:847-789-8597
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-230219163WN1003X
IL166.000713106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist