Healthcare Provider Details

I. General information

NPI: 1699131383
Provider Name (Legal Business Name): AGATA GUZEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 W IRVING PARK RD
CHICAGO IL
60634-2616
US

IV. Provider business mailing address

10564 S SUN VALLYE CT
PALOS HILL IL
60465
US

V. Phone/Fax

Practice location:
  • Phone: 773-685-8482
  • Fax: 773-685-8479
Mailing address:
  • Phone: 773-412-3846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146012654
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: