Healthcare Provider Details

I. General information

NPI: 1477663680
Provider Name (Legal Business Name): DOUGLAS CHARLES ZAPOTOCNY L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W 22ND ST SUITE 120
OAK BROOK IL
60523-1544
US

IV. Provider business mailing address

210 W 22ND ST SUITE 120
OAK BROOK IL
60523-1544
US

V. Phone/Fax

Practice location:
  • Phone: 708-848-9491
  • Fax: 630-572-1535
Mailing address:
  • Phone: 708-848-9491
  • Fax: 630-572-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: