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101 N Virginia St Ste 120 Crystal Lake IL 60014-3439 | |
| (815) 893-9544 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 101 N Virginia St Ste 120, Crystal Lake, Illinois |
| Authorized Official Name and Position | Jane W Zamudio (OWNER) |
| Authorized Official Contact | 2248000165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
101 N Virginia St Ste 120 Crystal Lake IL 60014-3439 Ph: (224) 762-5098 | 101 N Virginia St Ste 120 Crystal Lake IL 60014-3439 Ph: (815) 893-9544 |
| NPI Number | 1053028142 |
|---|---|
| Provider Enumeration Date | 10/31/2022 |
| Last Update Date | 02/02/2024 |
| Certification Date | 11/11/2022 |
| Medicare PECOS PAC ID | 9931540663 |
|---|---|
| Medicare Enrollment ID | O20240625003197 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053028142 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Jane Zamudio |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972220085 PECOS PAC ID: 7012358740 Enrollment ID: I20240624003093 |
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