Provider Demographics
NPI:1316255581
Name:ZILLY, DIANA RUTH (LCPC, NBCFCH)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:RUTH
Last Name:ZILLY
Suffix:
Gender:F
Credentials:LCPC, NBCFCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E GENEVA RD # 3020
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2438
Mailing Address - Country:US
Mailing Address - Phone:630-716-3939
Mailing Address - Fax:630-358-6620
Practice Address - Street 1:310 N HAMMES AVE
Practice Address - Street 2:302 B
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8118
Practice Address - Country:US
Practice Address - Phone:630-716-3939
Practice Address - Fax:630-358-6620
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009466101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.009466OtherIL DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATIONS