Provider Demographics
NPI:1205305117
Name:PYZIKIEWICZ, JENISABEL S (LCSW)
Entity type:Individual
Prefix:
First Name:JENISABEL
Middle Name:S
Last Name:PYZIKIEWICZ
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 1:10782 S OZARKS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5693
Mailing Address - Country:US
Mailing Address - Phone:203-820-3047
Mailing Address - Fax:
Practice Address - Street 1:10782 S OZARKS DR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5693
Practice Address - Country:US
Practice Address - Phone:203-820-3047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097800104100000X
UT11339443-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker