Provider Demographics
NPI:1659351849
Name:WALICEK, HOLLY ANN (ATC)
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:ANN
Last Name:WALICEK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 KINGSBURY DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-8283
Mailing Address - Country:US
Mailing Address - Phone:815-739-7726
Mailing Address - Fax:
Practice Address - Street 1:1030 W HIGGINS RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60195-3200
Practice Address - Country:US
Practice Address - Phone:847-885-0078
Practice Address - Fax:847-885-0026
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist