Healthcare Provider Details

I. General information

NPI: 1689658825
Provider Name (Legal Business Name): JANE V DYONZAK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 W LAKE AVE SUITE 404
GLENVIEW IL
60026-5801
US

IV. Provider business mailing address

3633 W LAKE AVE SUITE 404
GLENVIEW IL
60026-5801
US

V. Phone/Fax

Practice location:
  • Phone: 847-657-6007
  • Fax: 847-657-6412
Mailing address:
  • Phone: 847-657-6007
  • Fax: 847-657-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071004588
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: