Provider Demographics
NPI:1790426872
Name:MAZIK, JORDAN (MA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:MAZIK
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 1:13301 MAVERICK TRL
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8753
Mailing Address - Country:US
Mailing Address - Phone:817-991-4474
Mailing Address - Fax:
Practice Address - Street 1:1260 IROQUOIS AVE STE 200
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8548
Practice Address - Country:US
Practice Address - Phone:331-229-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst