Healthcare Provider Details

I. General information

NPI: 1659496321
Provider Name (Legal Business Name): KATARZYNA OLBRYCHT-CISZEWSKI ST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
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: 773-443-7454
  • Fax:
Mailing address:
  • Phone: 312-943-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number217000126
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242005550
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: