Provider Demographics
NPI:1023564432
Name:POLISTCHUK, MARIANA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIANA
Middle Name:
Last Name:POLISTCHUK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 REGENT DR
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2062
Mailing Address - Country:US
Mailing Address - Phone:224-392-8707
Mailing Address - Fax:
Practice Address - Street 1:1238 REGENT DR
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2062
Practice Address - Country:US
Practice Address - Phone:224-392-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-27
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242003966235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist