Healthcare Provider Details

I. General information

NPI: 1043898869
Provider Name (Legal Business Name): AMANDA MAUREEN ZEISEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST STE 404
OAK LAWN IL
60453-7216
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-3980
  • Fax: 708-520-1986
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.176415
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: