Healthcare Provider Details

I. General information

NPI: 1922325729
Provider Name (Legal Business Name): JEAN MARIE TSCHAMPA LOPOTKO PHARM.D, LCPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEAN MARIE TSCHAMPA LCPC

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MERTON AVE
GLEN ELLYN IL
60137-5203
US

IV. Provider business mailing address

311 MERTON AVE
GLEN ELLYN IL
60137-5203
US

V. Phone/Fax

Practice location:
  • Phone: 630-474-5935
  • Fax:
Mailing address:
  • Phone: 630-474-5935
  • Fax: 630-545-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number29530
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180008781
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051034790
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051034790
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: