Provider Demographics
NPI:1255572533
Name:ODWAZNY, JEAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:ODWAZNY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 SHERIDAN RD
Mailing Address - Street 2:STE 214
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2547
Mailing Address - Country:US
Mailing Address - Phone:847-363-3665
Mailing Address - Fax:
Practice Address - Street 1:1866 SHERIDAN RD
Practice Address - Street 2:STE 214
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2547
Practice Address - Country:US
Practice Address - Phone:847-363-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0134641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical