Jaq L Zuidema, LCSW, ASDCS, TIYT

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.028001 Issued in IL

Practice address

4000 W Montrose Ave # 790
Chicago, IL 60641-2140

Phone

(918) 558-0338

NPI assigned

Jun 8, 2017

Sex

Unspecified or another gender identity

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Autizen Therapy PLLC

  • Adult Mental Health Clinic/Center
  • Tulsa, OK
  • NPI 1700677804
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1043749310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8263 S HARVARD AVE # 1015",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741371614",
            "telephone_number": "918-558-0338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 W MONTROSE AVE # 790",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412140",
            "telephone_number": "918-558-0338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZUIDEMA",
        "first_name": "JAQ",
        "middle_name": "L",
        "credential": "LCSW, ASDCS, TIYT",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2017-06-08",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "21219",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.028001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Mary Zuengler, PHARMD
• Insia Zufer
• Morgan Marie Zugelder, MD
• Charles Zugerman, M.D.
• Elizabeth Marie Zuidema
• Loren Zuiderveld, M.D.
• Isabela Zuim Willis, MD
• Olga Zuk, M.D.
• J Zulaski
• Sara Zulghena, LPC

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.