Provider Demographics
NPI:1992567713
Name:RICK, SUSAN L (LCPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:RICK
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 1:473 N 2259TH RD
Mailing Address - Street 2:
Mailing Address - City:OGLESBY
Mailing Address - State:IL
Mailing Address - Zip Code:61348-9522
Mailing Address - Country:US
Mailing Address - Phone:815-814-7961
Mailing Address - Fax:
Practice Address - Street 1:473 N 2259TH RD
Practice Address - Street 2:
Practice Address - City:OGLESBY
Practice Address - State:IL
Practice Address - Zip Code:61348-9522
Practice Address - Country:US
Practice Address - Phone:815-814-7961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health