Provider Demographics
NPI:1811540479
Name:MISZTA, MARIE ELIZABETH (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELIZABETH
Last Name:MISZTA
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ELIZABETH
Other - Last Name:ORYBKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP/L
Mailing Address - Street 1:6550 N MINNETONKA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-2723
Mailing Address - Country:US
Mailing Address - Phone:773-551-0236
Mailing Address - Fax:
Practice Address - Street 1:975 E NERGE RD STE W20
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-4812
Practice Address - Country:US
Practice Address - Phone:224-520-8562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist