Provider Demographics
NPI:1164928719
Name:MATUZIK, DOMINIKA N
Entity Type:Individual
Prefix:
First Name:DOMINIKA
Middle Name:N
Last Name:MATUZIK
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 1:2516 WAUKEGAN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1774
Mailing Address - Country:US
Mailing Address - Phone:224-628-5823
Mailing Address - Fax:
Practice Address - Street 1:2516 WAUKEGAN RD
Practice Address - Street 2:STE 206
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:224-628-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146014335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist