Provider Demographics
NPI:1144286840
Name:STILWELL, SUZANNE H (MS, CGC)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:H
Last Name:STILWELL
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:MS
Other - First Name:SUZIE
Other - Middle Name:H
Other - Last Name:STILWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:6083 BUTTERCUP LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-8111
Mailing Address - Country:US
Mailing Address - Phone:815-227-9363
Mailing Address - Fax:
Practice Address - Street 1:2400 N ROCKTON AVE
Practice Address - Street 2:DEPT OF MEDICAL GENETICS, ROCKFORD MEMORIAL HOSPITAL
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3655
Practice Address - Country:US
Practice Address - Phone:815-971-5069
Practice Address - Fax:815-968-7830
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
96235170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS