Healthcare Provider Details

I. General information

NPI: 1164342705
Provider Name (Legal Business Name): SAMANTHA ZONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W CHICAGO AVE STE 200
CHICAGO IL
60654-5600
US

IV. Provider business mailing address

1718 N HONORE ST APT 1R
CHICAGO IL
60622-1332
US

V. Phone/Fax

Practice location:
  • Phone: 832-761-3176
  • Fax:
Mailing address:
  • Phone: 925-667-6996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: