Healthcare Provider Details

I. General information

NPI: 1902558083
Provider Name (Legal Business Name): KRYSTYNA CISZEK BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 N MONITOR AVE APT SUITE
CHICAGO IL
60634-5247
US

IV. Provider business mailing address

3020 N MONITOR AVE APT SUITE
CHICAGO IL
60634-5247
US

V. Phone/Fax

Practice location:
  • Phone: 773-610-5370
  • Fax:
Mailing address:
  • Phone: 773-610-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-57034
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: