Healthcare Provider Details

I. General information

NPI: 1437156999
Provider Name (Legal Business Name): PETER A DODZIK PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W GOLF RD STE 16
ARLINGTON HEIGHTS IL
60005-3923
US

IV. Provider business mailing address

415 W GOLF RD STE 16
ARLINGTON HEIGHTS IL
60005-3923
US

V. Phone/Fax

Practice location:
  • Phone: 847-577-0904
  • Fax:
Mailing address:
  • Phone: 847-577-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20041718
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071006408
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071006408
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: