Provider Demographics
NPI:1801824073
Name:KISHEL, SUZANNE (LCPC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:KISHEL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:WAHLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:8 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:IL
Mailing Address - Zip Code:61732-9197
Mailing Address - Country:US
Mailing Address - Phone:309-504-0259
Mailing Address - Fax:309-504-0259
Practice Address - Street 1:200 W MONROE ST
Practice Address - Street 2:SUITE 307B
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3997
Practice Address - Country:US
Practice Address - Phone:309-531-4721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005332101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional