Healthcare Provider Details

I. General information

NPI: 1871403899
Provider Name (Legal Business Name): STEPHANIE ZENZOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LEE ST
DES PLAINES IL
60018-1518
US

IV. Provider business mailing address

3150 W HIGGINS RD
HOFFMAN ESTATES IL
60169-7237
US

V. Phone/Fax

Practice location:
  • Phone: 844-599-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.012320
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: