Provider Demographics
NPI:1790916195
Name:ROSSELAND, SUSAN D (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:ROSSELAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-8811
Mailing Address - Country:US
Mailing Address - Phone:847-299-2526
Mailing Address - Fax:
Practice Address - Street 1:807 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-8811
Practice Address - Country:US
Practice Address - Phone:847-903-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0059051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical