Individual
SUSAN STASEK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST
Contact information
Practice address
2400 BELVIDERE RD, WAUKEGAN, IL 60085-6165
(847) 377-8440
Mailing address
3221 MIDLANE DRIVE, WADSWORTH, IL 60083-9457
(847) 293-0384
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
71005965
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71005965
LICENSE
IL
Enumeration date
01/27/2006
Last updated
12/09/2015
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