Individual
DR. SUSAN POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4972 BENCHMARK CENTRE, SUITE 200, SWANSEA, IL 62226
(618) 920-2663
Mailing address
P.O. BOX 2811, BLAINE, WA 98231
(618) 920-2663
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08232031
BLUE CROSS & BLUE SHIELD
IL
Enumeration date
05/01/2007
Last updated
07/08/2007
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