Healthcare Provider Details

I. General information

NPI: 1417623158
Provider Name (Legal Business Name): SHEREE WILICHOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N SHEFFIELD AVE
CHICAGO IL
60614-3936
US

IV. Provider business mailing address

655 W IRVING PARK RD APT 610
CHICAGO IL
60613-3167
US

V. Phone/Fax

Practice location:
  • Phone: 773-389-2202
  • Fax:
Mailing address:
  • Phone: 715-573-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.015838
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: