Provider Demographics
NPI:1952748824
Name:SANIIE, SUSAN HELEN (LACMAC)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:HELEN
Last Name:SANIIE
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Gender:F
Credentials:LACMAC
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Mailing Address - Street 1:P.O. BOX 100
Mailing Address - Street 2:GOYA HEALTH LTD.
Mailing Address - City:ENERGY
Mailing Address - State:IL
Mailing Address - Zip Code:62933
Mailing Address - Country:US
Mailing Address - Phone:618-988-9843
Mailing Address - Fax:618-942-8640
Practice Address - Street 1:202 S. PERSHING ST.
Practice Address - Street 2:GOYA HEALTH LTD.
Practice Address - City:ENERGY
Practice Address - State:IL
Practice Address - Zip Code:62933
Practice Address - Country:US
Practice Address - Phone:618-988-9843
Practice Address - Fax:618-942-8640
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2014-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL198.000779171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist