Healthcare Provider Details

I. General information

NPI: 1417296492
Provider Name (Legal Business Name): ASHLEY KUHL PIWOWARSKI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MADISON ST STE 200
OAK PARK IL
60302-4210
US

IV. Provider business mailing address

101 MADISON ST STE 200
OAK PARK IL
60302-4210
US

V. Phone/Fax

Practice location:
  • Phone: 708-859-8004
  • Fax: 708-628-3358
Mailing address:
  • Phone: 708-859-8004
  • Fax: 708-628-3358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008542
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: