Provider Demographics
NPI:1023876141
Name:ZEISS, TOM JOHN JR
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:JOHN
Last Name:ZEISS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 MOON LAKE BLVD STE 130140
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1069
Mailing Address - Country:US
Mailing Address - Phone:478-334-2824
Mailing Address - Fax:
Practice Address - Street 1:1721 MOON LAKE BLVD STE 130140
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1069
Practice Address - Country:US
Practice Address - Phone:478-334-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst