Healthcare Provider Details

I. General information

NPI: 1588443865
Provider Name (Legal Business Name): KAILA ZIMMERMAN MOSCOVITCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 N ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60004-6062
US

IV. Provider business mailing address

3100 DUNDEE RD STE 101
NORTHBROOK IL
60062-2462
US

V. Phone/Fax

Practice location:
  • Phone: 312-324-4502
  • Fax:
Mailing address:
  • Phone: 847-919-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150110920
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: