Healthcare Provider Details

I. General information

NPI: 1245064047
Provider Name (Legal Business Name): AMANDA ZOLOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 W BERWYN AVE STE 202
CHICAGO IL
60640-8168
US

IV. Provider business mailing address

800 N ELMWOOD AVE
OAK PARK IL
60302-1437
US

V. Phone/Fax

Practice location:
  • Phone: 773-234-3212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149030537
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: