Provider Demographics
NPI:1275977902
Name:DRUZIK, AMY NICHOLE (MA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:NICHOLE
Last Name:DRUZIK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15601 CICERO AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-3635
Mailing Address - Country:US
Mailing Address - Phone:708-687-3479
Mailing Address - Fax:
Practice Address - Street 1:15601 CICERO AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-3635
Practice Address - Country:US
Practice Address - Phone:708-687-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.008949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional