Provider Demographics
NPI:1285178483
Name:PALKO, ZOE
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:PALKO
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 1:1375 BRANCHWOOD CIR
Mailing Address - Street 2:102
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-0480
Mailing Address - Country:US
Mailing Address - Phone:231-357-6802
Mailing Address - Fax:
Practice Address - Street 1:2315 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-0897
Practice Address - Country:US
Practice Address - Phone:847-491-2518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004262390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program