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General NPI Number Information
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NPI Number | 1669603841
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Entity Type | Organization
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Legal Business Name | SUSAN ZBACNIK, LCSW, PC
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 1216 N SEMINARY AVE SUITE E
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City | WOODSTOCK
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State | IL
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Zip | 60098-4319
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Country | US
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Telephone | 847-767-9621
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Fax |
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Provider Business Mailing Address
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Address Line | 1216 N SEMINARY AVE SUITE E
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City | WOODSTOCK
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State | IL
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Zip | 60098-4319
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Country | US
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Telephone | 847-767-9621
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SUSAN JANE ZBACNIK
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Credential | LCSW
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Telephone | 847-767-9621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-012216
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License Number State | IL
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