Healthcare Provider Details

I. General information

NPI: 1932362746
Provider Name (Legal Business Name): TODD J ZIENTEK LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 BURLINGTON AVE
WESTERN SPRINGS IL
60558-1516
US

IV. Provider business mailing address

1000 S RAVEN RD
SHOREWOOD IL
60404-9151
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-0826
  • Fax:
Mailing address:
  • Phone: 815-725-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180-004433
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-004433
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: