Individual
SUSAN LONGLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
851 WASHINGTON BLVD APT A2, OAK PARK, IL 60302-3851
(708) 955-3934
Mailing address
851 WASHINGTON BLVD APT A2, OAK PARK, IL 60302-3851
(708) 955-3934
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
018447-1
NY
103TC0700X
Clinical Psychologist
Primary
071.008872
IL
Other
Enumeration date
01/02/2019
Last updated
01/02/2019
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