Provider Demographics
NPI:1629874540
Name:ANDERSON, ZACHARY M (MS, CPHIL)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MS, CPHIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 SHERIDAN RD APT I3
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3134
Mailing Address - Country:US
Mailing Address - Phone:505-917-0621
Mailing Address - Fax:
Practice Address - Street 1:704 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2908
Practice Address - Country:US
Practice Address - Phone:773-852-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist