Provider Demographics
NPI:1750968376
Name:BEDNARCZYK, EWA A (LCSW)
Entity type:Individual
Prefix:
First Name:EWA
Middle Name:A
Last Name:BEDNARCZYK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4732 N AUSTIN AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3785
Mailing Address - Country:US
Mailing Address - Phone:847-877-7626
Mailing Address - Fax:
Practice Address - Street 1:4732 N AUSTIN AVE UNIT A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3785
Practice Address - Country:US
Practice Address - Phone:847-877-7626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0230461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical