Provider Demographics
NPI:1992399968
Name:GREY, SUZANNE NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:NICOLE
Last Name:GREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SUZI
Other - Middle Name:NICOLE
Other - Last Name:GREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:180 W PARK AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3348
Mailing Address - Country:US
Mailing Address - Phone:630-216-4361
Mailing Address - Fax:877-428-7891
Practice Address - Street 1:180 W PARK AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3357
Practice Address - Country:US
Practice Address - Phone:331-642-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490269191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical