Susan Marie Lee

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

42989 Issued in IL

Practice address

26177 W Grass Lake Rd
Antioch, IL 60002-9613

Phone

(847) 395-1550

NPI assigned

Oct 8, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grass Lake School Dist No 36

  • Local Education Agency (LEA)
  • Antioch, IL
  • NPI 1205007648
  NPD (past)

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

{
    "created_epoch": "1570492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570492800000",
    "number": "1154963429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 CANNON RD",
            "city": "VOLO",
            "state": "IL",
            "postal_code": "600738180",
            "telephone_number": "847-207-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26177 W GRASS LAKE RD",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600029613",
            "telephone_number": "847-395-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-08",
        "last_updated": "2019-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "IL",
            "license": "42989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Antioch",
            "affiliation": "N",
            "address_1": "26177 W Grass Lake Rd",
            "city": "Antioch",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600029613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Julie C Kregel, PT, DPT
• Kathleen Bleyaert Krostal, PHD
• Jennifer L. Lacroix, M.A., CCC-SLP/L
• Lake County Immediate Care, LLC
• Stephanie Landazzi, LSW
• Michael J Leitza, PT
• Bonnie Lewis
• Lifeskills Center, LTD
• Gail Lindstrom, M.A., CCC-SLP
• Lisa M. Berg, LCSW and Associates, LLC

• School Psychologist in Antioch, IL
• Providers in Antioch, IL by specialty
• School Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2019; 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.