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General NPI Number Information
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NPI Number | 1790426872
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Entity Type | Individual
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Provider Name | JORDAN MAZIK MA
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 1260 IROQUOIS AVE STE 200
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City | NAPERVILLE
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State | IL
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Zip | 60563-8548
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Country | US
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Telephone | 331-229-3123
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Fax |
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Provider Business Mailing Address
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Address Line | 13301 MAVERICK TRL
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City | HOMER GLEN
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State | IL
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Zip | 60491-8753
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Country | US
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Telephone | 817-991-4474
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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