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Individual

DR. SUSANNAH MORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
302 RANDALL RD, GENEVA, IL 60134-4209
(630) 524-5845
(630) 208-3007
Mailing address
302 RANDALL RD, GENEVA, IL 60134-4209
(630) 524-5845
(630) 208-3007

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
071.007768
IL
103TC0700X
Clinical Psychologist
071.007768
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
071007768
IL
01
206147
MEDICARE (GROUP PTAN)
IL
01
F400100849
MEDICARE (INDIVIDUAL PTAN)
IL
Enumeration date
12/10/2012
Last updated
03/17/2018
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