Healthcare Provider Details

I. General information

NPI: 1427182476
Provider Name (Legal Business Name): PNINAH ZUCKER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 NORTH MICHIGAN AVENUE SUITE 914
CHICAGO IL
60601-5309
US

IV. Provider business mailing address

307 NORTH MICHIGAN AVENUE SUITE 914
CHICAGO IL
60601-5309
US

V. Phone/Fax

Practice location:
  • Phone: 312-909-9479
  • Fax: 312-943-9479
Mailing address:
  • Phone: 312-909-9479
  • Fax: 312-943-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-004212
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: