Provider Demographics
NPI:1588455315
Name:ILYIN, SUSAN ANN (APSW, LSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:ILYIN
Suffix:
Gender:F
Credentials:APSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1453 MEADOW RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4289
Mailing Address - Country:US
Mailing Address - Phone:847-977-5551
Mailing Address - Fax:
Practice Address - Street 1:4318 W CRYSTAL LAKE RD STE L
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4250
Practice Address - Country:US
Practice Address - Phone:815-531-8381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150014670104100000X
WI129919121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker