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General NPI Number Information
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NPI Number | 1104164730
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Entity Type | Organization
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Legal Business Name | IWONA KONCZAK, PSY.D., CORP
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 415 W GOLF RD SUITE 4
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-3929
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Country | US
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Telephone | 847-226-1810
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Fax |
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Provider Business Mailing Address
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Address Line | 415 W GOLF RD SUITE 4
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-3929
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/PRACTICE OWNER
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Name | DR. IWONA KONCZAK
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Credential | PSY.D.
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Telephone | 847-226-1810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-007687
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License Number State | IL
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