Healthcare Provider Details

I. General information

NPI: 1962219055
Provider Name (Legal Business Name): MONICA WOJCIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 GLADSTONE DR UNIT 203
NAPERVILLE IL
60565-1123
US

IV. Provider business mailing address

7625 GLADSTONE DR UNIT 203
NAPERVILLE IL
60565-1123
US

V. Phone/Fax

Practice location:
  • Phone: 630-418-2403
  • Fax:
Mailing address:
  • Phone: 630-418-2403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164008093
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: