1346364528 NPI number — MRS. SUSAN KAY SCHREIBER DEVILLEZ LCSW

Table of content: MRS. SUSAN KAY SCHREIBER DEVILLEZ LCSW (NPI 1346364528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346364528 NPI number — MRS. SUSAN KAY SCHREIBER DEVILLEZ LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHREIBER DEVILLEZ
Provider First Name:
SUSAN
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHREIBER
Provider Other First Name:
SUSAN
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346364528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 BLUFF AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAYSLAKE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60030-2312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-548-3602
Provider Business Mailing Address Fax Number:
847-543-0001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11801 SW HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 3CN
Provider Business Practice Location Address City Name:
PALOS HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60463-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-361-7435
Provider Business Practice Location Address Fax Number:
847-543-0001
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01673711 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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