Healthcare Provider Details

I. General information

NPI: 1679785760
Provider Name (Legal Business Name): MARIANNE BALTOWSKI M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LAKE COOK RD STE 101
DEERFIELD IL
60015
US

IV. Provider business mailing address

326 S GIBBONS AVE
ARLINGTON HEIGHTS IL
60004-6806
US

V. Phone/Fax

Practice location:
  • Phone: 847-940-9891
  • Fax: 847-964-9343
Mailing address:
  • Phone: 847-723-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number147000302
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: