Provider Demographics
NPI:1679291975
Name:KUEZI-NKE, SUWILANJI (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUWILANJI
Middle Name:
Last Name:KUEZI-NKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 GEORGIAN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8693
Mailing Address - Country:US
Mailing Address - Phone:678-751-9541
Mailing Address - Fax:
Practice Address - Street 1:2010 N DAMEN AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3284
Practice Address - Country:US
Practice Address - Phone:773-887-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.011208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical