MEDICARE: AMANDA ZALE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	180009015	IL
2	101YP2500X	Professional Counselor	180009015	IL

General Provider Information

NPI Number	:	1588131098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ZALE

Provider Business Mailing Address
First Line	:	4125 N WHIPPLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2511
Country	:	US
Telephone Number	:	559-284-6212
Fax Number	:

Provider Business Practice Location Address
First Line	:	4125 N WHIPPLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2511
Country	:	US
Telephone Number	:	559-284-6212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	11/21/2023

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Directions to “ AMANDA ZALE ” Practice Location

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