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General NPI Number Information
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NPI Number | 1215278122
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Entity Type | Individual
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Provider Name | JEFFREY S DANZIK LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 03/10/2014
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Provider Practice Location Address
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Address Line | 33 N CENTRAL AVE 400
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City | MEDFORD
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State | OR
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Zip | 97501-5900
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Country | US
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Telephone | 541-821-9422
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1109
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City | PHOENIX
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State | OR
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Zip | 97535-1109
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Country | US
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Telephone | 541-821-9422
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L5548
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License Number State | OR
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