Individual
AVA SUSSAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3759 W 95TH ST, SUITE 3, EVERGREEN PARK, IL 60805-2000
(866) 296-5262
(708) 636-6852
Mailing address
20 N CLARK ST, SUITE 2650, CHICAGO, IL 60602-4109
(866) 296-5262
(312) 558-1570
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149008560
IL
Other
Enumeration date
08/30/2011
Last updated
08/30/2011
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