Provider Demographics
NPI:1770047821
Name:FAVORS, SUZANNE ANTOINETTE (CRSS, CPRS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ANTOINETTE
Last Name:FAVORS
Suffix:
Gender:F
Credentials:CRSS, CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-2302
Mailing Address - Country:US
Mailing Address - Phone:630-414-6760
Mailing Address - Fax:
Practice Address - Street 1:ECKER CENTER FOR MENTAL HEALTH
Practice Address - Street 2:1845 GRANDSTAND PLACE
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4983
Practice Address - Country:US
Practice Address - Phone:847-695-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL34971OtherIODAPCA
IL35577OtherIODAPCA