Provider Demographics
NPI:1174640387
Name:ZAUCHA, JESSICA (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ZAUCHA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:650 E ALGONQUIN RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-3846
Mailing Address - Country:US
Mailing Address - Phone:847-221-5622
Mailing Address - Fax:847-221-5688
Practice Address - Street 1:675 N NORTH CT
Practice Address - Street 2:SUITE 285
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8157
Practice Address - Country:US
Practice Address - Phone:847-221-5622
Practice Address - Fax:847-221-5688
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150010352104100000X
IL149.0125811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker