Provider Demographics
NPI:1356101646
Name:SIOKOS, SUSAN (EDD, LCPC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:SIOKOS
Suffix:
Gender:F
Credentials:EDD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5129
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60204-5129
Mailing Address - Country:US
Mailing Address - Phone:773-704-0424
Mailing Address - Fax:
Practice Address - Street 1:1123 MAPLE AVE APT 3N
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-4252
Practice Address - Country:US
Practice Address - Phone:773-704-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health