Provider Demographics
NPI:1205962057
Name:SIY, SUSAN (MS LCPC QMHP QMRP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:SIY
Suffix:
Gender:F
Credentials:MS LCPC QMHP QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 GREENSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3308
Mailing Address - Country:US
Mailing Address - Phone:630-355-1576
Mailing Address - Fax:
Practice Address - Street 1:309 WEST NEW INDIAN TRAIL CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506
Practice Address - Country:US
Practice Address - Phone:630-966-4138
Practice Address - Fax:630-844-9011
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.000382101YM0800X
IL180-000382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional