Provider Demographics
NPI:1104278357
Name:SUZANNE ANDERER LE/CPE INC.
Entity type:Organization
Organization Name:SUZANNE ANDERER LE/CPE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR ELECTROLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ANDERER
Authorized Official - Suffix:
Authorized Official - Credentials:LE/CPE
Authorized Official - Phone:815-469-0050
Mailing Address - Street 1:8206 W WOODVALE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9171
Mailing Address - Country:US
Mailing Address - Phone:815-469-0050
Mailing Address - Fax:
Practice Address - Street 1:8206 W WOODVALE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9171
Practice Address - Country:US
Practice Address - Phone:815-469-0050
Practice Address - Fax:815-469-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL220.000021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty