Healthcare Provider Details

I. General information

NPI: 1750473823
Provider Name (Legal Business Name): KRISTIN ELIZABETH CICHOWSKI CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2641 N TALMAN AVE UNIT 1
CHICAGO IL
60647-1837
US

IV. Provider business mailing address

2641 N TALMAN AVE UNIT 1
CHICAGO IL
60647-1837
US

V. Phone/Fax

Practice location:
  • Phone: 708-606-4390
  • Fax: 773-384-1499
Mailing address:
  • Phone: 708-606-4390
  • Fax: 773-384-1499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: