Provider Demographics
NPI:1043452790
Name:CZYSZCZON, KAROLINA
Entity Type:Individual
Prefix:
First Name:KAROLINA
Middle Name:
Last Name:CZYSZCZON
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 1:4836 MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2594
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4836 MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2594
Practice Address - Country:US
Practice Address - Phone:847-589-2469
Practice Address - Fax:847-787-5323
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist