Healthcare Provider Details

I. General information

NPI: 1144740085
Provider Name (Legal Business Name): JOHN RODNEY SKOCZ LCPC, CAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27W350 HIGH LAKE RD
WINFIELD IL
60190-1262
US

IV. Provider business mailing address

770 FOXGLOVE DR
ALGONQUIN IL
60102-6319
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4673
  • Fax: 630-933-1933
Mailing address:
  • Phone: 847-989-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number29055
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.010250
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: