Provider Demographics
NPI:1972220085
Name:ZAMUDIO, JANE WOLFE (LCPC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:WOLFE
Last Name:ZAMUDIO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-4037
Mailing Address - Country:US
Mailing Address - Phone:224-800-0165
Mailing Address - Fax:
Practice Address - Street 1:101 N VIRGINIA ST STE 120
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3439
Practice Address - Country:US
Practice Address - Phone:224-800-0165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008216101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional