Provider Demographics
NPI:1730308388
Name:JANCZYKOWSKA, MALGORZATA (SLP)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:
Last Name:JANCZYKOWSKA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 AITKEN DR
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1834
Mailing Address - Country:US
Mailing Address - Phone:847-208-4681
Mailing Address - Fax:847-208-4681
Practice Address - Street 1:1435 AITKEN DR
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1834
Practice Address - Country:US
Practice Address - Phone:847-208-4681
Practice Address - Fax:847-208-4681
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist