Provider Demographics
NPI:1669593570
Name:SUSAN M. DUMMER LLC
Entity type:Organization
Organization Name:SUSAN M. DUMMER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-767-3370
Mailing Address - Street 1:122 BRAXTON WAY
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3493
Mailing Address - Country:US
Mailing Address - Phone:847-767-3370
Mailing Address - Fax:847-223-0032
Practice Address - Street 1:122 BRAXTON WAY
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3493
Practice Address - Country:US
Practice Address - Phone:847-767-3370
Practice Address - Fax:847-223-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty