Provider Demographics
NPI:1154666899
Name:KAHAN, SUSAN (MA, LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KAHAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S BRUNER ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1640 W. ROOSEVELT ROAD, (MC 727)
Practice Address - Street 2:FAMILY CLINIC, DEPT. OF DISABILITY AND HUMAN DEVEL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6904
Practice Address - Country:US
Practice Address - Phone:312-419-2652
Practice Address - Fax:312-413-1593
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008607101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional