Provider Demographics
NPI:1962578880
Name:PLUMMER, SUSAN L (LCPC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 CONCORD SQ
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3208
Mailing Address - Country:US
Mailing Address - Phone:847-263-0362
Mailing Address - Fax:847-263-0362
Practice Address - Street 1:128 NEWBERRY AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1923
Practice Address - Country:US
Practice Address - Phone:847-912-3895
Practice Address - Fax:847-263-0362
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional