=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316485519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OLSZEWSKI CENTER FOR WELLBEING, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2017
-----------------------------------------------------
Last Update Date | 02/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2S335 WILLIAMS RD
-----------------------------------------------------
City | WARRENVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60555-2234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-560-1451
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28379 DAVIS PKWY SUITE 801
-----------------------------------------------------
City | WARRENVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60555-3032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-508-6273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | DR. YOLANDA OLSZEWSKI
-----------------------------------------------------
Credential | PSYD, MPH
-----------------------------------------------------
Telephone | 312-508-6273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180009828
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------