Basic Information
| Provider Information | |||||||||
| NPI: | 1841699220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANUSKA | ||||||||
| FirstName: | DYLAN | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27555 DIEHL RD | ||||||||
| Address2: | ENTRANCE B | ||||||||
| City: | WARRENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605553849 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1220 HOBSON RD | ||||||||
| Address2: | STE 104 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605408139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306468000 | ||||||||
| FaxNumber: | 6306468007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2014 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 071008788 | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.