Provider Demographics
NPI:1093526378
Name:BAKBERGENOVA, ZHANSULU
Entity type:Individual
Prefix:
First Name:ZHANSULU
Middle Name:
Last Name:BAKBERGENOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 W HUBBARD ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-0002
Mailing Address - Country:US
Mailing Address - Phone:872-817-0372
Mailing Address - Fax:
Practice Address - Street 1:3100 DUNDEE RD STE 902
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2441
Practice Address - Country:US
Practice Address - Phone:888-628-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.115859104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty