Healthcare Provider Details

I. General information

NPI: 1417036112
Provider Name (Legal Business Name): LISA JEAN WASHKOWIAK M.A., CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 WESTWOOD TRL
WOODSTOCK IL
60098
US

IV. Provider business mailing address

1315 WESTWOOD TRL
WOODSTOCK IL
60098-7006
US

V. Phone/Fax

Practice location:
  • Phone: 847-421-9004
  • Fax:
Mailing address:
  • Phone: 847-421-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146006741
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: