Healthcare Provider Details

I. General information

NPI: 1972022614
Provider Name (Legal Business Name): ALICIA M ZUNIGA MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 FAIRVIEW DR
ROCHELLEE IL
61068
US

IV. Provider business mailing address

555 FAIRVIEW DR
ROCHELLE IL
61068
US

V. Phone/Fax

Practice location:
  • Phone: 815-562-9003
  • Fax:
Mailing address:
  • Phone: 815-568-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: