Provider Demographics
NPI:1881967396
Name:DZIUBAN, CHESTER JOSEPH (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:JOSEPH
Last Name:DZIUBAN
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 1:1801 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60481-1730
Mailing Address - Country:US
Mailing Address - Phone:815-529-6874
Mailing Address - Fax:
Practice Address - Street 1:1801 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-1730
Practice Address - Country:US
Practice Address - Phone:815-529-6874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490149801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical