Provider Demographics
NPI:1275296402
Name:ZANONA, KALI ELAINE
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:ELAINE
Last Name:ZANONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4449
Mailing Address - Country:US
Mailing Address - Phone:773-732-8828
Mailing Address - Fax:
Practice Address - Street 1:505 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4449
Practice Address - Country:US
Practice Address - Phone:773-732-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL702902103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool