Provider Demographics
NPI:1780741587
Name:SHOLTES, LCSW, SUSAN K (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:K
Last Name:SHOLTES, LCSW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:KENNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1560 SHERMAN AVE
Mailing Address - Street 2:SUITE 650
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4818
Mailing Address - Country:US
Mailing Address - Phone:847-328-1920
Mailing Address - Fax:847-328-1925
Practice Address - Street 1:1560 SHERMAN AVE
Practice Address - Street 2:SUITE 650
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4818
Practice Address - Country:US
Practice Address - Phone:847-328-1920
Practice Address - Fax:847-328-1925
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490059711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical