Healthcare Provider Details

I. General information

NPI: 1881607257
Provider Name (Legal Business Name): JULIE A. RUZYCKI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 N AVONDALE AVE SUITE 104
CHICAGO IL
60631-1962
US

IV. Provider business mailing address

6323 N AVONDALE AVE SUITE 104
CHICAGO IL
60631-1962
US

V. Phone/Fax

Practice location:
  • Phone: 773-467-0300
  • Fax: 847-568-9844
Mailing address:
  • Phone: 773-467-0300
  • Fax: 847-568-9844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-004878
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: