| Suzette Rush-drake, Psy.d. | |
|
241 Golf Mill Ctr Ste 602 Niles IL 60714-1215 | |
| (847) 390-0776 | |
| (847) 390-7625 |
| Full Name | Suzette Rush-drake, Psy.d. |
|---|---|
| Speciality | Psychologist |
| Location | 241 Golf Mill Ctr Ste 602, Niles, Illinois |
| Authorized Official Name and Position | Suzette Rush Drake (OWNER) |
| Authorized Official Contact | 8473900776 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Suzette Rush-drake, Psy.d. 241 Golf Mill Ctr Ste 602 Niles IL 60714-1215 Ph: (847) 390-0776 | Suzette Rush-drake, Psy.d. 241 Golf Mill Ctr Ste 602 Niles IL 60714-1215 Ph: (847) 390-0776 |
| NPI Number | 1760680789 |
|---|---|
| Provider Enumeration Date | 07/11/2007 |
| Last Update Date | 05/16/2012 |
| Medicare PECOS PAC ID | 8820003767 |
|---|---|
| Medicare Enrollment ID | O20060214000043 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760680789 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 071 004832 (Illinois) | Primary |
| Provider Name | Suzette D Rush Drake |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285712208 PECOS PAC ID: 2466467303 Enrollment ID: I20120605000685 |
Carol A. Gilbert, Ma, Lcpc, Ncc, Mn, Rn Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 241 Golf Mill Ctr, Suite 328, Niles, IL 60714 Phone: 847-212-8305 Fax: 847-635-5621 | |
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