Provider Demographics
NPI:1316293194
Name:RUDY, SUZANNE LYN
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:LYN
Last Name:RUDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 W ADDISON ST
Mailing Address - Street 2:#55
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4430
Mailing Address - Country:US
Mailing Address - Phone:330-328-2533
Mailing Address - Fax:
Practice Address - Street 1:4677 N VIRGINIA AVE
Practice Address - Street 2:1N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2953
Practice Address - Country:US
Practice Address - Phone:312-520-4657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst