1649485228 NPI number — MRS. ANTOINETTE JOSEPHINA ZUCHEL LCPC

Table of content: MRS. ANTOINETTE JOSEPHINA ZUCHEL LCPC (NPI 1649485228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649485228 NPI number — MRS. ANTOINETTE JOSEPHINA ZUCHEL LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZUCHEL
Provider First Name:
ANTOINETTE
Provider Middle Name:
JOSEPHINA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZUCHEL
Provider Other First Name:
TINA
Provider Other Middle Name:
JOSEPHINA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1649485228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
412 BELDEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60139-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-415-0343
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 N NAPERVILLE WHEATON RD
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60563-1557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-415-0343
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02232564 . This is a "BLUE CROSS BLUE SHEILD #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".