Provider Demographics
NPI:1316520901
Name:ALFORD, SUSAN REBECCA
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:REBECCA
Last Name:ALFORD
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 1:2660 BURR RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4052
Mailing Address - Country:US
Mailing Address - Phone:630-297-7769
Mailing Address - Fax:
Practice Address - Street 1:714 CLAY ST UNIT B
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3321
Practice Address - Country:US
Practice Address - Phone:309-332-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health