Healthcare Provider Details

I. General information

NPI: 1619803061
Provider Name (Legal Business Name): OLHA HOLUBOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W HOWARD ST
CHICAGO IL
60645-1228
US

IV. Provider business mailing address

675 GROVE DR APT 216
ELK GROVE VILLAGE IL
60007-1838
US

V. Phone/Fax

Practice location:
  • Phone: 773-305-6400
  • Fax:
Mailing address:
  • Phone: 224-398-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: