Healthcare Provider Details

I. General information

NPI: 1003324567
Provider Name (Legal Business Name): MARTA J POLKA ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 W DUNDEE RD
WHEELING IL
60090-3986
US

IV. Provider business mailing address

707 W VICTORIA LN
ARLINGTON HEIGHTS IL
60005-3657
US

V. Phone/Fax

Practice location:
  • Phone: 847-537-8270
  • Fax:
Mailing address:
  • Phone: 847-334-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2002627
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: