Provider Demographics
NPI:1053338988
Name:RESTKO, JOAN P (LCSW)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:P
Last Name:RESTKO
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 1:927 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4615
Mailing Address - Country:US
Mailing Address - Phone:847-323-2154
Mailing Address - Fax:
Practice Address - Street 1:735 ST. JOHNS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4615
Practice Address - Country:US
Practice Address - Phone:847-323-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0084581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4928133OtherBLUE SHIELD
IL4928133OtherBLUE SHIELD