Healthcare Provider Details

I. General information

NPI: 1891036125
Provider Name (Legal Business Name): MONICA SKOTNICKI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E GOLF RD SUITE 105
DES PLAINES IL
60016-1236
US

IV. Provider business mailing address

11325 WILD BERRY LN
MOKENA IL
60448-1372
US

V. Phone/Fax

Practice location:
  • Phone: 847-298-6446
  • Fax:
Mailing address:
  • Phone: 708-269-1483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.008488
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: