Healthcare Provider Details

I. General information

NPI: 1073428686
Provider Name (Legal Business Name): NATALIE IRENE BLAZYK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E DIEHL RD STE 123
NAPERVILLE IL
60563-4908
US

IV. Provider business mailing address

958 W BAUER RD
NAPERVILLE IL
60563-1109
US

V. Phone/Fax

Practice location:
  • Phone: 708-792-0162
  • Fax:
Mailing address:
  • Phone: 630-379-7178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number2763556
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: