Provider Demographics
NPI:1780237669
Name:HAWLEY, SUZANNE NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:NICOLE
Last Name:HAWLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:NICOLE
Other - Last Name:NATHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1617 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2745
Mailing Address - Country:US
Mailing Address - Phone:773-629-0864
Mailing Address - Fax:
Practice Address - Street 1:1617 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2745
Practice Address - Country:US
Practice Address - Phone:773-629-0864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490153161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical