Provider Demographics
NPI:1942715834
Name:OMIOTEK, DARCIE (SLP)
Entity Type:Individual
Prefix:
First Name:DARCIE
Middle Name:
Last Name:OMIOTEK
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 1:623 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MINONK
Mailing Address - State:IL
Mailing Address - Zip Code:61760-1020
Mailing Address - Country:US
Mailing Address - Phone:262-909-9998
Mailing Address - Fax:
Practice Address - Street 1:514 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-2477
Practice Address - Country:US
Practice Address - Phone:815-844-3924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist