| Doctor Name: | DR. SUSAN R SMITH |
| NPI Number: | 1033260047 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | |
| Business Practice Address: | 100 S Atkinson Rd Suite 203 Grayslake, IL - 600307817 |
| Business Phone Number: | 8475438378 |
| Business Fax Number: | 8475439424 |
| Mailing Address: | 1438 Thimbleweed Rd, GRAYSLAKE |
| State: | IL |
| Postal Code: | 600303563 |
| Phone Number: | 8475438378 |
| Fax Number: | 8475439424 |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |