Healthcare Provider Details

I. General information

NPI: 1891689881
Provider Name (Legal Business Name): CHAGIT ZUCKERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 OLD ORCHARD RD STE 200
SKOKIE IL
60077-4404
US

IV. Provider business mailing address

34700 VALLEY RD
OCONOMOWOC WI
53066-4500
US

V. Phone/Fax

Practice location:
  • Phone: 800-767-4411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149017058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: