MEDICARE: JOSHUA DAVID RUZICH LPC

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	101YP2500X	Professional Counselor	178014756	IL

General Provider Information

NPI Number	:	1952941130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA DAVID RUZICH LPC

Provider Business Mailing Address
First Line	:	9631 W 153RD ST STE 37
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-3778
Country	:	US
Telephone Number	:	773-340-2644
Fax Number	:

Provider Business Practice Location Address
First Line	:	9631 W 153RD ST STE 37
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-3778
Country	:	US
Telephone Number	:	773-340-2644
Fax Number	:

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

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	01/15/2020

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Directions to “ JOSHUA DAVID RUZICH LPC” Practice Location

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