Provider Demographics
NPI:1427318849
Name:PUNZO, JESSICA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:PUNZO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LAKE ST STE 614
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1136
Mailing Address - Country:US
Mailing Address - Phone:708-613-0344
Mailing Address - Fax:833-303-3737
Practice Address - Street 1:1010 LAKE ST STE 614
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1136
Practice Address - Country:US
Practice Address - Phone:708-613-0344
Practice Address - Fax:833-303-3737
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical