Provider Demographics
NPI:1033361878
Name:GAZZOLO, SUZANNE DRON (PHD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:DRON
Last Name:GAZZOLO
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 1:1110 N LAKE SHORE DR APT 28N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1023
Mailing Address - Country:US
Mailing Address - Phone:847-280-0564
Mailing Address - Fax:
Practice Address - Street 1:1110 N LAKE SHORE DR APT 28N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1023
Practice Address - Country:US
Practice Address - Phone:847-280-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00315400101YP2500X
IL180.006314101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional