Provider Demographics
NPI:1033889456
Name:RADZIK, ALIA D
Entity Type:Individual
Prefix:
First Name:ALIA
Middle Name:D
Last Name:RADZIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 RAND RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3509
Mailing Address - Country:US
Mailing Address - Phone:847-376-2117
Mailing Address - Fax:
Practice Address - Street 1:1800 N HERMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1161
Practice Address - Country:US
Practice Address - Phone:224-509-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362170821Medicaid