Provider Demographics
NPI:1184731218
Name:RUZICH, JEAN R (MA LCPC)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:R
Last Name:RUZICH
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9631 W 153RD ST
Mailing Address - Street 2:SUITE 37
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462
Mailing Address - Country:US
Mailing Address - Phone:708-764-5201
Mailing Address - Fax:708-361-1781
Practice Address - Street 1:9631 W 153RD ST
Practice Address - Street 2:SUITE 37
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462
Practice Address - Country:US
Practice Address - Phone:708-764-5201
Practice Address - Fax:708-361-1781
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1632448OtherBCBS