Healthcare Provider Details

I. General information

NPI: 1750759643
Provider Name (Legal Business Name): MONIQUE PROHASKA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 S WASHINGTON ST
NAPERVILLE IL
60540-6643
US

IV. Provider business mailing address

16159 ONTARIO ST
CREST HILL IL
60403-0758
US

V. Phone/Fax

Practice location:
  • Phone: 815-514-8992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE PROHASKA-SLATTERY
Title or Position: LCPC
Credential:
Phone: 815-514-8992