Provider Demographics
NPI:1396462107
Name:TETRICK, OKSANA ALEXANDROVNA III
Entity type:Individual
Prefix:MS
First Name:OKSANA
Middle Name:ALEXANDROVNA
Last Name:TETRICK
Suffix:III
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 1:452 MEADOWLARK CIR APT A
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-9561
Mailing Address - Country:US
Mailing Address - Phone:815-570-1977
Mailing Address - Fax:
Practice Address - Street 1:452 MEADOWLARK CIR APT A
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-9561
Practice Address - Country:US
Practice Address - Phone:815-570-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL217.0004492355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant