Healthcare Provider Details

I. General information

NPI: 1679769848
Provider Name (Legal Business Name): JANET G RUZICH MSW, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 S BLOOMINGDALE RD SUITE 112
BLOOMINGDALE IL
60108-1492
US

IV. Provider business mailing address

148 S BLOOMINGDALE RD SUITE 112
BLOOMINGDALE IL
60108-1492
US

V. Phone/Fax

Practice location:
  • Phone: 630-894-4451
  • Fax:
Mailing address:
  • Phone: 630-894-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178003596
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: