MEDICARE: PENELOPE JOHANNA ZEIGLER LCSW

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	104100000X	Social Worker	150011536	IL

General Provider Information

NPI Number	:	1336301209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENELOPE JOHANNA ZEIGLER LCSW

Provider Business Mailing Address
First Line	:	5000 S 5TH AVE
Second Line	:
City	:	HINES
State	:	IL
Zip	:	60141-3030
Country	:	US
Telephone Number	:	708-202-8387
Fax Number	:	708-202-3650

Provider Business Practice Location Address
First Line	:	4542 N DRAKE AVE # 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5904
Country	:	US
Telephone Number	:	773-641-9904
Fax Number	:

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

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	04/10/2018

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