Healthcare Provider Details

I. General information

NPI: 1194156729
Provider Name (Legal Business Name): VADIM SITNYAKOVSKIY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2013
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 N WINSLOWE DR
PALATINE IL
60074-0108
US

IV. Provider business mailing address

1553 N WINSLOWE DR
PALATINE IL
60074-0108
US

V. Phone/Fax

Practice location:
  • Phone: 773-470-8617
  • Fax:
Mailing address:
  • Phone: 773-470-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.008673
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180008673
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: