Provider Demographics
NPI:1871263475
Name:DWORSACK, MONA MARIE (AUD, CCC-A, FAAA)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:MARIE
Last Name:DWORSACK
Suffix:
Gender:F
Credentials:AUD, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1113
Mailing Address - Country:US
Mailing Address - Phone:309-338-4605
Mailing Address - Fax:
Practice Address - Street 1:7301 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2017
Practice Address - Country:US
Practice Address - Phone:309-589-8051
Practice Address - Fax:309-689-0312
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001835231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist