Provider Demographics
NPI:1952185225
Name:ZHANG, JIAXUAN
Entity Type:Individual
Prefix:
First Name:JIAXUAN
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:ZHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5213
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60204-5213
Mailing Address - Country:US
Mailing Address - Phone:847-565-6400
Mailing Address - Fax:
Practice Address - Street 1:1854 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3795
Practice Address - Country:US
Practice Address - Phone:847-565-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical