Provider Demographics
NPI:1659008167
Name:CZAJKOWSKYJ, ROBERT (LSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CZAJKOWSKYJ
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11239 S SAINT LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4647
Mailing Address - Country:US
Mailing Address - Phone:773-370-3360
Mailing Address - Fax:
Practice Address - Street 1:9021 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-2040
Practice Address - Country:US
Practice Address - Phone:708-354-4547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.108513104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker