Provider Demographics
NPI:1770027732
Name:MARSHALL, C. SUSANNE (LMP,MMP)
Entity Type:Individual
Prefix:MS
First Name:C.
Middle Name:SUSANNE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LMP,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N MARINE DR
Mailing Address - Street 2:#7L
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3274
Mailing Address - Country:US
Mailing Address - Phone:815-666-4873
Mailing Address - Fax:
Practice Address - Street 1:5100 N MARINE DR
Practice Address - Street 2:#7L
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3274
Practice Address - Country:US
Practice Address - Phone:773-620-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-10
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227007320225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist