Provider Demographics
NPI:1770616773
Name:ZWILLING, STEPHANIE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANN
Last Name:ZWILLING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4944
Mailing Address - Country:US
Mailing Address - Phone:847-409-6230
Mailing Address - Fax:
Practice Address - Street 1:2715 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4944
Practice Address - Country:US
Practice Address - Phone:847-409-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490109121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635233Medicare UPIN