MEDICARE: THE OCTOBER ROOM, PLLC

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	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180009015	OTHER	IL	IDFPR

General Provider Information

NPI Number	:	1417802430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE OCTOBER ROOM, PLLC

Provider Business Mailing Address
First Line	:	2501 CHATHAM RD STE N
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4188
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4125 N WHIPPLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2511
Country	:	US
Telephone Number	:	559-284-6212
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SOLE MEMBER
Name	:	AMANDA ZALE
Credential	:	LCPC
Telephone Number	:	559-284-6212

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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Directions to “THE OCTOBER ROOM, PLLC ” Practice Location

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