1316255581 NPI number — MS. DIANA RUTH ZILLY LCPC, NBCFCH

Table of content: MS. DIANA RUTH ZILLY LCPC, NBCFCH (NPI 1316255581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316255581 NPI number — MS. DIANA RUTH ZILLY LCPC, NBCFCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZILLY
Provider First Name:
DIANA
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC, NBCFCH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316255581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
335 E GENEVA RD # 3020
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROL STREAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60188-2438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-716-3939
Provider Business Mailing Address Fax Number:
630-358-6620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 N HAMMES AVE
Provider Second Line Business Practice Location Address:
302 B
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60435-8118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-716-3939
Provider Business Practice Location Address Fax Number:
630-358-6620
Provider Enumeration Date:
09/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180.009466 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 180.009466 . This is a "IL DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATIONS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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