Healthcare Provider Details

I. General information

NPI: 1306186655
Provider Name (Legal Business Name): JILLIAN E DZURNAK SCHOOL PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 HOSIER ST
SELBYVILLE DE
19975-9300
US

IV. Provider business mailing address

31 HOSIER ST
SELBYVILLE DE
19975-9300
US

V. Phone/Fax

Practice location:
  • Phone: 302-856-4783
  • Fax: 302-856-4784
Mailing address:
  • Phone: 302-436-1000
  • Fax: 302-436-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number63496
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: