Healthcare Provider Details

I. General information

NPI: 1740902857
Provider Name (Legal Business Name): VANESSA M ZAPATA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 OAKMONT LN
WESTMONT IL
60559-5551
US

IV. Provider business mailing address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

V. Phone/Fax

Practice location:
  • Phone: 877-552-6672
  • Fax: 224-306-1878
Mailing address:
  • Phone: 224-306-1879
  • Fax: 224-306-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.103588
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: