Provider Demographics
NPI:1992715544
Name:ZEDNIK, DEANNA L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:L
Last Name:ZEDNIK
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 1:771 THACKERAY DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4062
Mailing Address - Country:US
Mailing Address - Phone:847-432-1345
Mailing Address - Fax:847-432-3436
Practice Address - Street 1:771 THACKERAY DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4062
Practice Address - Country:US
Practice Address - Phone:847-432-1345
Practice Address - Fax:847-432-3436
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID01621363OtherBLUE SHIELD PROVIDER NUMB