Organization
BIRCHWOOD CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN MARIE BUSH PSYD (PSYCHOLOGIST, OWNER)
(312) 806-2140
Entity
Organization
Contact information
Practice address
2302 W NORTH AVE STE 1E, CHICAGO, IL 60647-9755
(312) 806-2140
Mailing address
2302 W NORTH AVE STE 1E, CHICAGO, IL 60647-9755
(312) 806-2140
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071009612
IL
Other
Enumeration date
10/04/2017
Last updated
10/04/2017
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