Healthcare Provider Details

I. General information

NPI: 1528675758
Provider Name (Legal Business Name): ANETA MARZENA RYCHTARCZYK SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5222 SPRING CREEK RD
ROCKFORD IL
61114-6330
US

IV. Provider business mailing address

874 ARTHUR DR
ELGIN IL
60120-3116
US

V. Phone/Fax

Practice location:
  • Phone: 815-654-4960
  • Fax:
Mailing address:
  • Phone: 708-248-3512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146015356
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242005445
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: