Healthcare Provider Details

I. General information

NPI: 1962928259
Provider Name (Legal Business Name): PAOULA JEDZINIAK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAOULA DYANOVA PSYD

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26W171 ROOSEVELT RD
WHEATON IL
60187-6002
US

IV. Provider business mailing address

26W171 ROOSEVELT RD
WHEATON IL
60187-6002
US

V. Phone/Fax

Practice location:
  • Phone: 630-909-7000
  • Fax: 630-909-7002
Mailing address:
  • Phone: 630-909-7000
  • Fax: 630-909-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071010818
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: