MEDICARE: SUZANNE DRON GAZZOLO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	37PC00315400	NJ
2	101YP2500X	Professional Counselor	180.006314	IL

General Provider Information

NPI Number	:	1033361878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE DRON GAZZOLO PH.D.

Provider Business Mailing Address
First Line	:	1110 N LAKE SHORE DR APT 28N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-1023
Country	:	US
Telephone Number	:	847-280-0564
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 N LAKE SHORE DR APT 28N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-1023
Country	:	US
Telephone Number	:	847-280-0564
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	10/12/2021

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