Healthcare Provider Details

I. General information

NPI: 1417467721
Provider Name (Legal Business Name): ASHLYN JILL ZINCK LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLYN JILL PADEN

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CLARK ST # 1061
CHICAGO IL
60640-2829
US

IV. Provider business mailing address

1443 W WAVELAND AVE APT 2
CHICAGO IL
60613-3727
US

V. Phone/Fax

Practice location:
  • Phone: 502-517-6054
  • Fax:
Mailing address:
  • Phone: 502-517-6054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.013993
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: