Provider Demographics
NPI:1043577174
Name:LINIEWIECKA-DZIWOK, AGNIESZKA (LCPC)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:LINIEWIECKA-DZIWOK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EAST OGDEN AVENUE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:630-325-8893
Mailing Address - Fax:630-325-8939
Practice Address - Street 1:1375 E SCHAUMBURG ROAD
Practice Address - Street 2:SUITE 230
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194
Practice Address - Country:US
Practice Address - Phone:847-895-4540
Practice Address - Fax:847-895-4544
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007964174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178.007964OtherILLINOIS PROFESSIONAL LICENSE
IL180009544OtherILLINOIS LICENSE