| Doctor Name: | MS. SUSAN ROBERTA DAVIS |
| NPI Number: | 1568418739 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC, NCSP, CDS |
| License Number: | SS12630298P |
| Business Practice Address: | 3804 11th St Winthrop Harbor, IL - 600961461 |
| Business Phone Number: | 8475021007 |
| Business Fax Number: | 8153019025 |
| Mailing Address: | 3804 11th St, WINTHROP HARBOR |
| State: | IL |
| Postal Code: | 600961461 |
| Phone Number: | 8475021007 |
| Fax Number: | 8153019025 |
| NPI Enumeration Date: | 05/26/2006 |
| NPI Last Update Date: | 07/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | SS12630298P |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |