Provider Demographics
NPI:1457570251
Name:DR. SUSAN MYKET, P.C.
Entity Type:Organization
Organization Name:DR. SUSAN MYKET, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MYKET
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-212-2049
Mailing Address - Street 1:1415 BOND ST
Mailing Address - Street 2:SUITE 127
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2388
Mailing Address - Country:US
Mailing Address - Phone:630-212-2049
Mailing Address - Fax:866-441-1136
Practice Address - Street 1:1415 BOND ST
Practice Address - Street 2:SUITE 127
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2388
Practice Address - Country:US
Practice Address - Phone:630-212-2049
Practice Address - Fax:866-441-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X, 103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty