Provider Demographics
NPI:1427182476
Name:ZUCKER, PNINAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:PNINAH
Middle Name:
Last Name:ZUCKER
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 1:307 NORTH MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 914
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5309
Mailing Address - Country:US
Mailing Address - Phone:312-909-9479
Mailing Address - Fax:312-943-9479
Practice Address - Street 1:307 NORTH MICHIGAN AVENUE
Practice Address - Street 2:SUITE 914
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5309
Practice Address - Country:US
Practice Address - Phone:312-909-9479
Practice Address - Fax:312-943-9479
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004212103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001673598OtherBLUE CROSS BLUE SHIELD
IL579760Medicare PIN
IL0001673598OtherBLUE CROSS BLUE SHIELD
IL579770Medicare PIN
IL963340Medicare PIN