Individual
SUSAN M GULLICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
9634 S PULASKI RD, OAK LAWN, IL 60453-3391
(708) 423-4800
(708) 423-4843
Mailing address
PO BOX 2427, ORLAND PARK, IL 60462-1089
(815) 834-2400
(815) 834-2424
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1623066
BCBS PROVIDER #
IL
01
—
CJ4383
R.R. MEDICARE GROUP #
IL
Enumeration date
09/02/2006
Last updated
07/08/2007
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