Healthcare Provider Details

I. General information

NPI: 1922099019
Provider Name (Legal Business Name): JUDY G. DZIUGAS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2005
Last Update Date: 09/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W PARK AVE #115
ELMHURST IL
60126-3357
US

IV. Provider business mailing address

180 W PARK AVE #130
ELMHURST IL
60126-3357
US

V. Phone/Fax

Practice location:
  • Phone: 630-279-0845
  • Fax: 630-530-4441
Mailing address:
  • Phone: 630-279-0845
  • Fax: 630-530-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071005781
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: