Provider Demographics
NPI:1487778056
Name:COLLINS, SUZANNE MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:MICHELLE
Other - Last Name:STAPLETON-COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2264 REFLECTIONS DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-7309
Mailing Address - Country:US
Mailing Address - Phone:630-898-9569
Mailing Address - Fax:
Practice Address - Street 1:1725 S NAPERVILLE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-8155
Practice Address - Country:US
Practice Address - Phone:630-462-7005
Practice Address - Fax:630-462-7006
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71007222103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical