Healthcare Provider Details

I. General information

NPI: 1992946222
Provider Name (Legal Business Name): MRS. CARRIE SKOCZYLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5728 S. NORMANDY AVENUE
CHICAGO IL
60638
US

IV. Provider business mailing address

5728 S. NORMANDY AVENUE
CHICAGO IL
60638
US

V. Phone/Fax

Practice location:
  • Phone: 773-788-0018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: