Provider Demographics
NPI:1508466624
Name:ZOLECKI, CARLY BELLE (LSW)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:BELLE
Last Name:ZOLECKI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:BELLE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:870 APPLETREE CT
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1207 MCHENRY RD STE 217B
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1371
Practice Address - Country:US
Practice Address - Phone:224-676-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL150.105514104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program