MEDICARE: MARIA ELZBIETA GORECKA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1447982848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ELZBIETA GORECKA

Provider Business Mailing Address
First Line	:	5124 S LECLAIRE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-3030
Country	:	US
Telephone Number	:	773-697-1834
Fax Number	:

Provider Business Practice Location Address
First Line	:	5124 S LECLAIRE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-3030
Country	:	US
Telephone Number	:	773-697-1834
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2022
Last Update Date	:	06/26/2022

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