Provider Demographics
NPI:1467850925
Name:ZUCK, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ZUCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14413 MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:IL
Mailing Address - Zip Code:61078-9265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14413 MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:SHANNON
Practice Address - State:IL
Practice Address - Zip Code:61078-9265
Practice Address - Country:US
Practice Address - Phone:815-541-4984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health