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General NPI Number Information
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NPI Number | 1609544782
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Entity Type | Individual
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Provider Name | KHADIJA MANZOOR
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Gender | Female
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 501 DAVIS ST
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City | EVANSTON
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State | IL
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Zip | 60201-4619
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Country | US
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Telephone | 312-815-9660
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Fax |
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Provider Business Mailing Address
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Address Line | 5816 LINCOLN AVE
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City | MORTON GROVE
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State | IL
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Zip | 60053-3344
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Country | US
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Telephone | 312-813-8842
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 500642
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License Number State | IL
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