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General NPI Number Information
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NPI Number | 1043685589
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Entity Type | Individual
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Provider Name | MS. AGNIESZKA ALINA WYSOCKA
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Gender | Female
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 4419 W NORTH AVE
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City | MELROSE PARK
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State | IL
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Zip | 60160-1021
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Country | US
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Telephone | 773-777-7112
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Fax | 708-547-7732
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Provider Business Mailing Address
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Address Line | 2010 HASSELL RD APT #201
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-6340
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Country | US
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Telephone | 847-922-2210
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180005556
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License Number State | IL
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