Provider Demographics
NPI:1215278122
Name:DANZIK, JEFFREY S (LCSW)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:DANZIK
Suffix:
Gender:M
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:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-1109
Mailing Address - Country:US
Mailing Address - Phone:541-821-9422
Mailing Address - Fax:
Practice Address - Street 1:33 N CENTRAL AVE
Practice Address - Street 2:400
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-5900
Practice Address - Country:US
Practice Address - Phone:541-821-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL55481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical