Provider Demographics
NPI:1306186655
Name:DZURNAK, JILLIAN E (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:E
Last Name:DZURNAK
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HOSIER ST
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-9300
Mailing Address - Country:US
Mailing Address - Phone:302-436-1000
Mailing Address - Fax:302-436-1034
Practice Address - Street 1:31 HOSIER ST
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-9300
Practice Address - Country:US
Practice Address - Phone:302-856-4783
Practice Address - Fax:302-856-4784
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE63496103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool