Healthcare Provider Details

I. General information

NPI: 1811130586
Provider Name (Legal Business Name): JACQUELINE ZAGRANS LMFT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E. DUNDEE RD BUILDING 4/SUITE 100
BARRINGTON IL
60010
US

IV. Provider business mailing address

4440 HARBOR CIR
HOFFMAN ESTATES IL
60192-1012
US

V. Phone/Fax

Practice location:
  • Phone: 330-472-4540
  • Fax: 847-220-9299
Mailing address:
  • Phone: 330-472-4540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.000758
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: