Healthcare Provider Details

I. General information

NPI: 1104164730
Provider Name (Legal Business Name): IWONA KONCZAK, PSY.D., CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W GOLF RD SUITE 4
ARLINGTON HEIGHTS IL
60005-3929
US

IV. Provider business mailing address

415 W GOLF RD SUITE 4
ARLINGTON HEIGHTS IL
60005-3929
US

V. Phone/Fax

Practice location:
  • Phone: 847-226-1810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-007687
License Number StateIL

VIII. Authorized Official

Name: DR. IWONA KONCZAK
Title or Position: PSYCHOLOGIST/PRACTICE OWNER
Credential: PSY.D.
Phone: 847-226-1810