Provider Demographics
NPI:1962534297
Name:HUNTZINGER, NANCY J (PSYD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:HUNTZINGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:HUNTZINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:120 OAKBROOK CENTER
Mailing Address - Street 2:SUITE 720
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:630-336-6172
Mailing Address - Fax:630-920-1299
Practice Address - Street 1:120 OAKBROOK CENTER
Practice Address - Street 2:SUITE 720
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:630-336-6172
Practice Address - Fax:630-368-0123
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005192103TC0700X, 103T00000X
103TA0700X, 103TC1900X, 103TF0000X, 103TH0100X, 103T00000X
IL971-005192174400000X
IL071-005192103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBCBSOtherBCBS