MEDICARE: DR. ALYSON KAY ZALTA 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	103TC0700X	Clinical Psychologist	071008763	IL

General Provider Information

NPI Number	:	1598172397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALYSON KAY ZALTA PH.D.

Provider Business Mailing Address
First Line	:	33 W ONTARIO ST
Second Line	:	APT 30B
City	:	CHICAGO
State	:	IL
Zip	:	60654-7760
Country	:	US
Telephone Number	:	513-638-8166
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 W JACKSON BLVD STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3244
Country	:	US
Telephone Number	:	312-563-2828
Fax Number	:	312-942-4990

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

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/14/2014

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