Provider Demographics
NPI:1962928259
Name:JEDZINIAK, PAOULA (PSYD)
Entity type:Individual
Prefix:
First Name:PAOULA
Middle Name:
Last Name:JEDZINIAK
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:PAOULA
Other - Middle Name:
Other - Last Name:DYANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:26W171 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6002
Mailing Address - Country:US
Mailing Address - Phone:630-909-7000
Mailing Address - Fax:630-909-7002
Practice Address - Street 1:26W171 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-6002
Practice Address - Country:US
Practice Address - Phone:630-909-7000
Practice Address - Fax:630-909-7002
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010818103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty