Provider Demographics
NPI:1407978810
Name:GROCHOWSKA, AGNIESZKA AGATA (DEVELOPMENTAL THERAP)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:AGATA
Last Name:GROCHOWSKA
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 THUNDER RDG
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-4827
Mailing Address - Country:US
Mailing Address - Phone:773-895-1367
Mailing Address - Fax:847-658-3080
Practice Address - Street 1:424 THUNDER RDG
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-4827
Practice Address - Country:US
Practice Address - Phone:773-895-1367
Practice Address - Fax:847-658-3080
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAG47341000P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist