Individual
DR. SUSANNAH MORE
Active
Individual
DR. SUSANNAH MORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
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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