Healthcare Provider Details

I. General information

NPI: 1952941130
Provider Name (Legal Business Name): JOSHUA DAVID RUZICH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9631 W 153RD ST STE 37
ORLAND PARK IL
60462-3778
US

IV. Provider business mailing address

9631 W 153RD ST STE 37
ORLAND PARK IL
60462-3778
US

V. Phone/Fax

Practice location:
  • Phone: 773-340-2644
  • Fax:
Mailing address:
  • Phone: 773-340-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178014756
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: