Organization · NPI-2
Susan R. Davis Therapies, INC.
Early Intervention Provider Agency · Gurnee, IL
NPI number1104171917
StatusActive
Last updated in NPPESMar 12, 2025
Details
- NPI
- 1104171917
- Entity type
- Organization (NPI-2)
- Legal business name
- Susan R. Davis Therapies, INC.
- Organization subpart
- No
- Enumeration date
- Jul 17, 2012
- Certification date
- Mar 12, 2025
- Last updated
- Mar 12, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 252Y00000X | Early Intervention Provider Agency | 180.007623 | IL | Yes |
| 101YP2500X | Counselor, Professional | – | – | |
| 222Q00000X | Developmental Therapist | – | – | |
| 251S00000X | Community/Behavioral Health | 180.007623 | IL |
Practice location
2845 Valley View RdGurnee, IL 60031-1041
Phone 847-502-1007 · Fax 815-301-9025
Mailing address
2845 Valley View RdGurnee, IL 60031-1041
Phone 847-502-1007 · Fax 815-301-9025
Authorized official
Susan Roberta Davis
President
8475021007
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