Healthcare Provider Details

I. General information

NPI: 1043435282
Provider Name (Legal Business Name): MARK EUGENE ZIPPRICH LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 BUTTERFIELD RD SUITE 138S
OAK BROOK IL
60523-3418
US

IV. Provider business mailing address

2625 BUTTERFIELD RD SUITE 138S
OAK BROOK IL
60523-3418
US

V. Phone/Fax

Practice location:
  • Phone: 630-234-5553
  • Fax: 630-528-3805
Mailing address:
  • Phone: 630-234-5553
  • Fax: 630-528-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180006155
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: