Provider Demographics
NPI:1629489711
Name:ZERKLE, BROCK STEVEN (LCSW)
Entity Type:Individual
Prefix:
First Name:BROCK
Middle Name:STEVEN
Last Name:ZERKLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5313 N LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-4315
Mailing Address - Country:US
Mailing Address - Phone:618-843-1975
Mailing Address - Fax:
Practice Address - Street 1:102 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448-1900
Practice Address - Country:US
Practice Address - Phone:618-783-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0155631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical