Provider Demographics
NPI:1306910229
Name:ZEIGER, ILENE BETH (PHD)
Entity type:Individual
Prefix:DR
First Name:ILENE
Middle Name:BETH
Last Name:ZEIGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N LINCOLN PARK W APT 8M
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4736
Mailing Address - Country:US
Mailing Address - Phone:773-248-5668
Mailing Address - Fax:
Practice Address - Street 1:2000 N RACINE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4045
Practice Address - Country:US
Practice Address - Phone:773-929-8584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001673194OtherBLUE CROSS BLUE SHIELD