Provider Demographics
NPI:1255942660
Name:TREZEVANT, SUZANNE GERVAIS (LCSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:GERVAIS
Last Name:TREZEVANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2123
Mailing Address - Country:US
Mailing Address - Phone:708-415-4066
Mailing Address - Fax:
Practice Address - Street 1:715 LAKE ST STE 417
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1413
Practice Address - Country:US
Practice Address - Phone:708-415-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
IL1490103771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical