Provider Demographics
NPI:1376046060
Name:ZALOUM, KIRSTIN ANN (MS)
Entity Type:Individual
Prefix:MS
First Name:KIRSTIN
Middle Name:ANN
Last Name:ZALOUM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 W LILL AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-8587
Mailing Address - Country:US
Mailing Address - Phone:847-970-2983
Mailing Address - Fax:
Practice Address - Street 1:858 W LILL AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-8587
Practice Address - Country:US
Practice Address - Phone:847-970-2983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist