Provider Demographics
NPI:1295483428
Name:OSEI, SUSANNE LELLO (NCC)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:LELLO
Last Name:OSEI
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W TERRA COTTA AVE # 243
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3548
Mailing Address - Country:US
Mailing Address - Phone:847-508-5293
Mailing Address - Fax:
Practice Address - Street 1:175 OLDE HALF DAY RD STE 140-9
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3062
Practice Address - Country:US
Practice Address - Phone:847-508-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1096361101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor