Provider Demographics
NPI:1235393794
Name:SAWICKI, TRINA J (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:J
Last Name:SAWICKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-1904
Mailing Address - Country:US
Mailing Address - Phone:815-488-4914
Mailing Address - Fax:
Practice Address - Street 1:930 7TH ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-1904
Practice Address - Country:US
Practice Address - Phone:815-488-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.000162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist