Provider Demographics
NPI:1922325729
Name:TSCHAMPA LOPOTKO, JEAN MARIE (PHARMD, LCPC, CADC)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:TSCHAMPA LOPOTKO
Suffix:
Gender:F
Credentials:PHARMD, LCPC, CADC
Other - Prefix:DR
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:TSCHAMPA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:311 MERTON AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5203
Mailing Address - Country:US
Mailing Address - Phone:630-474-5935
Mailing Address - Fax:630-545-3630
Practice Address - Street 1:311 MERTON AVE
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5203
Practice Address - Country:US
Practice Address - Phone:630-474-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL29530101YA0400X
IL051034790183500000X, 1835P0018X, 1835P0018X
IL180008781101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist