Healthcare Provider Details

I. General information

NPI: 1184731218
Provider Name (Legal Business Name): JEAN R RUZICH MA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9631 W 153RD ST SUITE 37
ORLAND PARK IL
60462
US

IV. Provider business mailing address

9631 W 153RD ST SUITE 37
ORLAND PARK IL
60462
US

V. Phone/Fax

Practice location:
  • Phone: 708-764-5201
  • Fax: 708-361-1781
Mailing address:
  • Phone: 708-764-5201
  • Fax: 708-361-1781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: