=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326889643
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAGDALENA GORNIAK LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2024
-----------------------------------------------------
Last Update Date | 06/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 552 S WASHINGTON ST STE 115
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60540-6669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-339-9832
-----------------------------------------------------
Fax | 630-857-9101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 371 MARTINGALE AVE
-----------------------------------------------------
City | ROMEOVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60446-1785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-275-3294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 150110521
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------