Provider Demographics
NPI:1639339922
Name:ZAVADA, AMY (LMFT)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:ZAVADA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 N WHIPPLE ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3836
Mailing Address - Country:US
Mailing Address - Phone:817-946-1282
Mailing Address - Fax:
Practice Address - Street 1:4452 N WHIPPLE ST
Practice Address - Street 2:UNIT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3836
Practice Address - Country:US
Practice Address - Phone:817-946-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist