Healthcare Provider Details

I. General information

NPI: 1962319541
Provider Name (Legal Business Name): MICELYS ZUNIGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 W 103RD ST
OAK LAWN IL
60453-4718
US

IV. Provider business mailing address

1911 RIDGELAND AVE
BERWYN IL
60402-2030
US

V. Phone/Fax

Practice location:
  • Phone: 331-229-8843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: