Healthcare Provider Details

I. General information

NPI: 1548173222
Provider Name (Legal Business Name): ISABEL GINA ZLATNIKOV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N CLEVELAND AVE
CHICAGO IL
60610-3663
US

IV. Provider business mailing address

808 N CLEVELAND AVE
CHICAGO IL
60610-3663
US

V. Phone/Fax

Practice location:
  • Phone: 847-977-4994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: