Provider Demographics
NPI:1659496321
Name:OLBRYCHT-CISZEWSKI, KATARZYNA (ST)
Entity Type:Individual
Prefix:
First Name:KATARZYNA
Middle Name:
Last Name:OLBRYCHT-CISZEWSKI
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 N ELSTON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2449
Mailing Address - Country:US
Mailing Address - Phone:312-943-3600
Mailing Address - Fax:
Practice Address - Street 1:1467 N ELSTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2449
Practice Address - Country:US
Practice Address - Phone:773-443-7454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2170001262355S0801X
IL242005550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL103034Medicaid
IL147715Medicare ID - Type Unspecified