Basic Information
| Provider Information | |||||||||
| NPI: | 1932362746 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIENTEK | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 S RAVEN RD | ||||||||
| Address2: | |||||||||
| City: | SHOREWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604049151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157253170 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1023 BURLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | WESTERN SPRINGS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605581516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083540826 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2008 | ||||||||
| LastUpdateDate: | 07/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 180-004433 | IL | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.