Provider Demographics
NPI:1720574148
Name:OLSZAK, KARYN M
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:M
Last Name:OLSZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 N SPRINGFIELD AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6213
Mailing Address - Country:US
Mailing Address - Phone:224-305-1203
Mailing Address - Fax:
Practice Address - Street 1:511 WHISPERING PINES RD
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-8717
Practice Address - Country:US
Practice Address - Phone:224-305-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-18-31341103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst