Healthcare Provider Details

I. General information

NPI: 1154703403
Provider Name (Legal Business Name): ROBIN ZAZOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 W EXECUTIVE DR SUITE 450
ADDISON IL
60101-5625
US

IV. Provider business mailing address

1515 W PHEASANT TRAIL LN UNIT 6
ARLINGTON HEIGHTS IL
60004-7605
US

V. Phone/Fax

Practice location:
  • Phone: 224-436-7392
  • Fax:
Mailing address:
  • Phone: 224-436-7392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: