Provider Demographics
NPI:1295946366
Name:WISEHART, SUSAN (MS, NCSP, LMFT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:WISEHART
Suffix:
Gender:F
Credentials:MS, NCSP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 WOODVIEW RD APT D
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1775
Mailing Address - Country:US
Mailing Address - Phone:847-438-7878
Mailing Address - Fax:
Practice Address - Street 1:25671 HILLVIEW CT
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-9436
Practice Address - Country:US
Practice Address - Phone:847-438-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16600159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist