MEDICARE: DR. JANE V DYONZAK PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071004588	IL

General Provider Information

NPI Number	:	1689658825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE V DYONZAK PH.D.

Provider Business Mailing Address
First Line	:	3633 W LAKE AVE
Second Line	:	SUITE 404
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5801
Country	:	US
Telephone Number	:	847-657-6007
Fax Number	:	847-657-6412

Provider Business Practice Location Address
First Line	:	3633 W LAKE AVE
Second Line	:	SUITE 404
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5801
Country	:	US
Telephone Number	:	847-657-6007
Fax Number	:	847-657-6412

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	09/25/2008

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