Healthcare Provider Details

I. General information

NPI: 1376677732
Provider Name (Legal Business Name): RANDI ZOOT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 W JEFFERSON ST
JOLIET IL
60435-5261
US

IV. Provider business mailing address

3033 W JEFFERSON ST
JOLIET IL
60435-5261
US

V. Phone/Fax

Practice location:
  • Phone: 815-729-4070
  • Fax:
Mailing address:
  • Phone: 815-729-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: