Provider Demographics
NPI:1780773267
Name:SHRIFTER-FIALKOW, SUSAN
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:SHRIFTER-FIALKOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6942
Mailing Address - Country:US
Mailing Address - Phone:312-245-3120
Mailing Address - Fax:312-245-3124
Practice Address - Street 1:435 N MICHIGAN AVE
Practice Address - Street 2:SUITE 2800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4066
Practice Address - Country:US
Practice Address - Phone:312-245-3120
Practice Address - Fax:312-245-3124
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490029461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL162-0249OtherBLUE CROSS/BLUE SHIELD
IL162-0249OtherBLUE CROSS/BLUE SHIELD