Provider Demographics
NPI:1841806445
Name:ZUBKUS, TANIA GRACE (LCSW)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:GRACE
Last Name:ZUBKUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 ASHLAND AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1175
Mailing Address - Country:US
Mailing Address - Phone:708-274-7945
Mailing Address - Fax:
Practice Address - Street 1:1544 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1175
Practice Address - Country:US
Practice Address - Phone:708-274-7945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0236391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.023639OtherIDFPR