Provider Demographics
NPI:1851975668
Name:ZUCKER, KATE ELYSE (LSW)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:ELYSE
Last Name:ZUCKER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 W WELLINGTON AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5448
Mailing Address - Country:US
Mailing Address - Phone:708-699-1999
Mailing Address - Fax:
Practice Address - Street 1:5138 N CLARK ST FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2828
Practice Address - Country:US
Practice Address - Phone:917-518-5907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.105105104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker