Individual ProviderJaq L ZuidemaSocial WorkerBehavioral Health & Social Service ProvidersPractice Address4000 W Montrose Ave # 790, Chicago, IL 60641-2140(918) 558-0338PECOS EnrollmentBased on the most recent information from CMS, provider Jaq L Zuidema does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1043749310Provider TypeIndividualFull NameZuidema, Jaq LCredentialLCSW, ASDCS, TIYTSole ProprietorYesEnumeration Date6/8/2017Last Updated5/14/2025Contact InformationPractice LocationPractice Address4000 W Montrose Ave # 790, Chicago, IL 60641-2140Phone(918) 558-0338FaxUnlisted FaxMailing LocationMailing Address8263 S Harvard Ave # 1015, Tulsa, OK 74137-1614Phone(918) 558-0338FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense149.028001IllinoisCode101YM0800XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode1041C0700XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense21219OklahomaCode171M00000XDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer