Provider Demographics
NPI:1881865517
Name:AGNIESZKA GROCHOWSKA DT INC
Entity type:Organization
Organization Name:AGNIESZKA GROCHOWSKA DT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CDS
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGNIESZKA
Authorized Official - Middle Name:AGATA
Authorized Official - Last Name:GROCHOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-895-1367
Mailing Address - Street 1:424 THUNDER RDG
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-4827
Mailing Address - Country:US
Mailing Address - Phone:773-895-1367
Mailing Address - Fax:847-658-3080
Practice Address - Street 1:424 THUNDER RDG
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-4827
Practice Address - Country:US
Practice Address - Phone:773-895-1367
Practice Address - Fax:847-658-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency