Healthcare Provider Details

I. General information

NPI: 1275977902
Provider Name (Legal Business Name): AMY NICHOLE DRUZIK M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15601 CICERO AVE SUITE 103
OAK FOREST IL
60452-3635
US

IV. Provider business mailing address

15601 CICERO AVE SUITE 103
OAK FOREST IL
60452-3635
US

V. Phone/Fax

Practice location:
  • Phone: 708-687-3479
  • Fax:
Mailing address:
  • Phone: 708-687-3479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.008949
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: