Provider Demographics
NPI:1942705678
Name:ESTOYE, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ESTOYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25501 ECR 750 N
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:IL
Mailing Address - Zip Code:62633
Mailing Address - Country:US
Mailing Address - Phone:217-671-0722
Mailing Address - Fax:
Practice Address - Street 1:208 N WEST AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IL
Practice Address - Zip Code:62664-1066
Practice Address - Country:US
Practice Address - Phone:217-482-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool