Healthcare Provider Details

I. General information

NPI: 1316255581
Provider Name (Legal Business Name): DIANA RUTH ZILLY LCPC, NBCFCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N HAMMES AVE 302 B
JOLIET IL
60435-8118
US

IV. Provider business mailing address

335 E GENEVA RD # 3020
CAROL STREAM IL
60188-2438
US

V. Phone/Fax

Practice location:
  • Phone: 630-716-3939
  • Fax: 630-358-6620
Mailing address:
  • Phone: 630-716-3939
  • Fax: 630-358-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.009466
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: