Provider Demographics
NPI:1881185437
Name:LETTO, SUSANNE M (RBT-17-44095)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:M
Last Name:LETTO
Suffix:
Gender:F
Credentials:RBT-17-44095
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 VOSE DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3101
Mailing Address - Country:US
Mailing Address - Phone:847-224-2887
Mailing Address - Fax:
Practice Address - Street 1:905 VOSE DR
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3101
Practice Address - Country:US
Practice Address - Phone:847-224-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-17-44095106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician