Provider Demographics
NPI:1598954588
Name:JIANG, ZHUJUN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ZHUJUN
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6343
Mailing Address - Country:US
Mailing Address - Phone:309-944-7833
Mailing Address - Fax:309-403-0554
Practice Address - Street 1:3816 27TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6343
Practice Address - Country:US
Practice Address - Phone:309-944-7833
Practice Address - Fax:309-403-0554
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009562103TC0700X
IL178.004933106H00000X
IL178004933101YP2500X
IL179004933101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370984175OtherBRIDGEWAY TAX ID