Provider Demographics
NPI:1982958112
Name:ZAKOWSKI, SANDRA GABRIELE (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:GABRIELE
Last Name:ZAKOWSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 N WOOD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1326
Mailing Address - Country:US
Mailing Address - Phone:773-848-2768
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE STE 905
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7454
Practice Address - Country:US
Practice Address - Phone:773-848-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12441219OtherCAQH