Provider Demographics
NPI:1730417361
Name:JEFSON, KATHY ZEBRACKI (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:ZEBRACKI
Last Name:JEFSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:ZEBRACKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:SHRINERS HOSPITALS FOR CHILDREN
Mailing Address - Street 2:P. O. BOX 8500, LOCKBOX 7642
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8115
Mailing Address - Fax:813-281-8656
Practice Address - Street 1:2211 N. OAK PARK
Practice Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3351
Practice Address - Country:US
Practice Address - Phone:773-385-5832
Practice Address - Fax:773-385-5488
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical