NPIMap

Organization Active NPI

Susan R. Davis Therapies, Inc.

  • Early Intervention Provider Agency
  • Gurnee, IL
National Provider Identifier
1104171917
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
180.007623 Issued in IL
Legal business name
SUSAN R. DAVIS THERAPIES, INC.
Practice address
2845 Valley View Rd
Gurnee, IL 60031-1041
Phone
(847) 502-1007
Fax
(815) 301-9025
NPI assigned
Jul 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan Roberta Davis, LCPCNPI 1568418739
Title
President
Phone
(847) 502-1007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Developmental TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 222Q00000X
Community/Behavioral Health Agency 251S00000X 180.007623 IL
Early Intervention Provider Agency 252Y00000X 180.007623 IL Primary

Addresses

Primary practice location

2845 Valley View Rd
Gurnee, IL 60031-1041

Mailing address

2845 Valley View Rd
Gurnee, IL 60031-1041
Phone (847) 502-1007

Other identifiers 2

IdentifierTypeStateIssuer
180.007623OtherILILLINOIS DEPT OF PROFESSIONAL AND FINANCIAL LICENSES
SS12630298POtherILILLINOIS EARLY INTERVENTION

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741737600000",
    "number": "1104171917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 VALLEY VIEW RD",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600311041",
            "telephone_number": "847-502-1007",
            "fax_number": "815-301-9025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 VALLEY VIEW RD",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600311041",
            "telephone_number": "847-502-1007",
            "fax_number": "815-301-9025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN R. DAVIS THERAPIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-17",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "ROBERTA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-502-1007",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "180.007623",
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "IL",
            "license": "180.007623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS DEPT OF PROFESSIONAL AND FINANCIAL LICENSES",
            "identifier": "180.007623",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS EARLY INTERVENTION",
            "identifier": "SS12630298P",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.