Healthcare Provider Details

I. General information

NPI: 1033961057
Provider Name (Legal Business Name): ZUCKERMAN WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 05/23/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E RANDOLPH ST UNIT 1106
CHICAGO IL
60601-7453
US

IV. Provider business mailing address

340 E RANDOLPH ST UNIT 1106
CHICAGO IL
60601-7453
US

V. Phone/Fax

Practice location:
  • Phone: 312-219-5714
  • Fax:
Mailing address:
  • Phone: 312-219-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: REBECCA CHICO ZUCKERMAN
Title or Position: OWNER
Credential: LCSW
Phone: 312-219-5714