Provider Demographics
NPI:1063729911
Name:DRZONEK-EDWARDS, ERICA D (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:D
Last Name:DRZONEK-EDWARDS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:D
Other - Last Name:DRZONEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D
Mailing Address - Street 1:15 SPINNING WHEEL RD.
Mailing Address - Street 2:SUITE 426
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:630-323-3050
Mailing Address - Fax:630-323-3058
Practice Address - Street 1:15 SPINNING WHEEL RD.
Practice Address - Street 2:SUITE 426
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-323-3050
Practice Address - Fax:630-323-3058
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008820103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071.008820OtherIL LICENSE #
IL1633920OtherBLUE CROSS BLUE SHEILD ORGANIZATION IDENTIFIER