Basic Information
| Provider Information | |||||||||
| NPI: | 1902827546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAGOTTA | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | FRANCIS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8700 WEST BRYN MAWR AVE | ||||||||
| Address2: | STE 800 SOUTH | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778075120 | ||||||||
| FaxNumber: | 5742581898 | ||||||||
| Practice Location | |||||||||
| Address1: | 8700 WEST BRYN MAWR AVE | ||||||||
| Address2: | STE 800 SOUTH | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778075120 | ||||||||
| FaxNumber: | 5742581898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 20040933A | IN | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.