Healthcare Provider Details

I. General information

NPI: 1942346325
Provider Name (Legal Business Name): INTERNATIONAL CONSULTING GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 N ELSTON AVE STE 103
CHICAGO IL
60642-2449
US

IV. Provider business mailing address

1467 N ELSTON AVE STE 103
CHICAGO IL
60642-2449
US

V. Phone/Fax

Practice location:
  • Phone: 312-943-3600
  • Fax: 312-943-3096
Mailing address:
  • Phone: 312-943-3600
  • Fax: 312-943-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number1010149
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 12
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1010149
License Number StateIL
# 13
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010149
License Number StateIL
# 14
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1010149
License Number StateIL

VIII. Authorized Official

Name: MS. IWONA KORZENIOWSKA
Title or Position: PRESIDENT
Credential: PT
Phone: 312-943-3600