Healthcare Provider Details

I. General information

NPI: 1386765642
Provider Name (Legal Business Name): THOMAS SLONKA LCSW, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SALT CREEK LN STE 202
HINSDALE IL
60521-2903
US

IV. Provider business mailing address

8 SALT CREEK LN STE 202
HINSDALE IL
60521-2903
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-2505
  • Fax: 331-221-2719
Mailing address:
  • Phone: 331-221-2505
  • Fax: 331-221-2719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.002799
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16634
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: