Healthcare Provider Details

I. General information

NPI: 1063664589
Provider Name (Legal Business Name): VIVIENNE A OSKVAREK LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N HAMMES AVE
JOLIET IL
60435-6677
US

IV. Provider business mailing address

9940 LA REINA CT
ORLAND PARK IL
60462-3138
US

V. Phone/Fax

Practice location:
  • Phone: 708-606-4725
  • Fax: 708-460-3688
Mailing address:
  • Phone: 708-606-4725
  • Fax: 708-460-3688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.006273
License Number StateIL

VIII. Authorized Official

Name: MRS. VIVIENNE A OSKVAREK
Title or Position: PROFESSIONAL COUNSELOR
Credential: MA LCPC CADC MISA II
Phone: 708-606-4725