Healthcare Provider Details

I. General information

NPI: 1588417398
Provider Name (Legal Business Name): KAMILA SMYK JAWORSKI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S PROSPECT AVE # 315
PARK RIDGE IL
60068-4037
US

IV. Provider business mailing address

919 N PLUM GROVE RD STE C
SCHAUMBURG IL
60173-4760
US

V. Phone/Fax

Practice location:
  • Phone: 708-856-7343
  • Fax:
Mailing address:
  • Phone: 847-413-9700
  • Fax: 847-413-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071011193
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: