Doctor Name: | NICOLE D ZOELLER |
NPI Number: | 1184827644 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 149.016168 |
Business Practice Address: | 1820 N Sterling Ave West Peoria, IL - 616046433 |
Business Phone Number: | 3094531596 |
Business Fax Number: | |
Mailing Address: | 1501 Cashel Dr, BLOOMINGTON |
State: | IL |
Postal Code: | 617044136 |
Phone Number: | 3094531596 |
Fax Number: | |
NPI Enumeration Date: | 06/11/2007 |
NPI Last Update Date: | 09/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149.016168 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |