1306186655 NPI number — JILLIAN E DZURNAK SCHOOL PSYCHOLOGIST

Table of content: JILLIAN E DZURNAK SCHOOL PSYCHOLOGIST (NPI 1306186655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306186655 NPI number — JILLIAN E DZURNAK SCHOOL PSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DZURNAK
Provider First Name:
JILLIAN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SCHOOL PSYCHOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306186655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 HOSIER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELBYVILLE
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19975-9300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-436-1000
Provider Business Mailing Address Fax Number:
302-436-1034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 HOSIER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELBYVILLE
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19975-9300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-856-4783
Provider Business Practice Location Address Fax Number:
302-856-4784
Provider Enumeration Date:
02/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X , with the licence number:  63496 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com