Provider Demographics
NPI:1366622763
Name:MCLANE, SUZANNE KATHERINE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:KATHERINE
Last Name:MCLANE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33197 N SEARS BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2177
Mailing Address - Country:US
Mailing Address - Phone:847-370-2177
Mailing Address - Fax:
Practice Address - Street 1:33197 N SEARS BLVD
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2177
Practice Address - Country:US
Practice Address - Phone:847-370-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001814235Z00000X
IL146009007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665711Medicaid