Provider Demographics
NPI:1104171917
Name:SUSAN R. DAVIS THERAPIES, INC.
Entity type:Organization
Organization Name:SUSAN R. DAVIS THERAPIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ROBERTA
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-502-1007
Mailing Address - Street 1:2845 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1041
Mailing Address - Country:US
Mailing Address - Phone:847-502-1007
Mailing Address - Fax:815-301-9025
Practice Address - Street 1:2845 VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1041
Practice Address - Country:US
Practice Address - Phone:847-502-1007
Practice Address - Fax:815-301-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 222Q00000X
IL180.007623251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.007623OtherILLINOIS DEPT OF PROFESSIONAL AND FINANCIAL LICENSES
ILSS12630298POtherILLINOIS EARLY INTERVENTION