Provider Demographics
NPI:1750723359
Name:DOMLEWSKI, IWONA (DT)
Entity type:Individual
Prefix:
First Name:IWONA
Middle Name:
Last Name:DOMLEWSKI
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S RUGA CT
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3586
Mailing Address - Country:US
Mailing Address - Phone:630-543-0744
Mailing Address - Fax:
Practice Address - Street 1:127 S RUGA CT
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3586
Practice Address - Country:US
Practice Address - Phone:630-543-0744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist