Provider Demographics
NPI:1093006546
Name:BERLOWSKI, NICOLE (MS)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:BERLOWSKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4649
Mailing Address - Country:US
Mailing Address - Phone:715-600-2211
Mailing Address - Fax:
Practice Address - Street 1:1501 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-4649
Practice Address - Country:US
Practice Address - Phone:715-600-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI474202693Medicaid