MEDICARE: JZGC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1427439520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JZGC LLC

Provider Business Mailing Address
First Line	:	2420 W WINNEMAC AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 W WINNEMAC AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2614
Country	:	US
Telephone Number	:	773-720-0068
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	JEFFREY ZACHARIAS
Credential	:	LCSW
Telephone Number	:	773-720-0068

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	06/15/2015

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