Provider Demographics
NPI:1346768017
Name:SIMON, JEANETTE ZWICKY (PSYD ,CADC)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:ZWICKY
Last Name:SIMON
Suffix:
Gender:F
Credentials:PSYD ,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LAKE STREET
Mailing Address - Street 2:SUITE 210 B
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301
Mailing Address - Country:US
Mailing Address - Phone:708-628-7578
Mailing Address - Fax:
Practice Address - Street 1:1100 LAKE STREET
Practice Address - Street 2:SUITE 210 B
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:708-628-7578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2018-01-08
Deactivation Date:2017-11-08
Deactivation Code:
Reactivation Date:2018-01-08
Provider Licenses
StateLicense IDTaxonomies
IL071.005823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical