MEDICARE: ZAYA A GILLOGLY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	149.022857	IL

General Provider Information

NPI Number	:	1225512023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAYA A GILLOGLY LCSW

Provider Business Mailing Address
First Line	:	3547 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3945
Country	:	US
Telephone Number	:	773-490-5148
Fax Number	:

Provider Business Practice Location Address
First Line	:	3547 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3945
Country	:	US
Telephone Number	:	773-490-5148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	10/21/2024

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