Provider Demographics
NPI:1316391675
Name:DZIKOWSKI, MATEUSZ (PSYD)
Entity type:Individual
Prefix:DR
First Name:MATEUSZ
Middle Name:
Last Name:DZIKOWSKI
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MANCHESTER RD STE 1510
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4561
Mailing Address - Country:US
Mailing Address - Phone:630-653-1717
Mailing Address - Fax:630-653-7926
Practice Address - Street 1:2100 MANCHESTER RD STE 1510
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4561
Practice Address - Country:US
Practice Address - Phone:630-653-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009279103T00000X, 103TC0700X, 103TC0700X
103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral