Provider Demographics
NPI:1912054826
Name:BUSS, SUSAN M (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:BUSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2220
Mailing Address - Country:US
Mailing Address - Phone:708-366-8363
Mailing Address - Fax:708-366-8212
Practice Address - Street 1:7326 HARRISON ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2017
Practice Address - Country:US
Practice Address - Phone:708-642-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical