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General NPI Number Information
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NPI Number | 1396147427
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Entity Type | Individual
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Provider Name | MAUREEN OLENICZAK M.S.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 1700 W CORTLAND ST
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City | CHICAGO
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State | IL
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Zip | 60622-1131
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Country | US
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Telephone | 877-486-4140
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Fax |
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Provider Business Mailing Address
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Address Line | 950 LEE ST SUITE 210
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City | DES PLAINES
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State | IL
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Zip | 60016-6532
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Country | US
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Telephone | 616-634-9434
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 242003247
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License Number State | IL
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