Healthcare Provider Details

I. General information

NPI: 1053811133
Provider Name (Legal Business Name): NICOLE M. ZOOK MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 44TH ST STE 5
ROCK ISLAND IL
61201-7187
US

IV. Provider business mailing address

4709 44TH ST STE 5
ROCK ISLAND IL
61201-7187
US

V. Phone/Fax

Practice location:
  • Phone: 309-793-3460
  • Fax:
Mailing address:
  • Phone: 309-793-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.011802
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: