Healthcare Provider Details

I. General information

NPI: 1609730175
Provider Name (Legal Business Name): ARIEL ZIEMBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 S BLUE ISLAND AVE STE 1
CHICAGO IL
60608-2238
US

IV. Provider business mailing address

7807 S DOBSON AVE
CHICAGO IL
60619-3203
US

V. Phone/Fax

Practice location:
  • Phone: 312-584-0559
  • Fax:
Mailing address:
  • Phone: 708-427-6381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21196238
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: