Provider Demographics
NPI:1881240661
Name:ZAKOS, ANN MARIE
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:ZAKOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4044
Mailing Address - Country:US
Mailing Address - Phone:847-668-4869
Mailing Address - Fax:
Practice Address - Street 1:120 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4044
Practice Address - Country:US
Practice Address - Phone:847-668-4869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178014555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health