Provider Demographics
NPI:1124693775
Name:ZANNOU, DOXA JESUMEVO (MA)
Entity type:Individual
Prefix:
First Name:DOXA
Middle Name:JESUMEVO
Last Name:ZANNOU
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 W JACKSON BLVD STE 1201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4192
Mailing Address - Country:US
Mailing Address - Phone:312-772-9796
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 1201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4192
Practice Address - Country:US
Practice Address - Phone:312-772-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health