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General NPI Number Information
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NPI Number | 1497520399
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Entity Type | Individual
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Provider Name | DREW POLACZEK
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Gender | Female
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 44 W ROOSEVELT RD
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City | LOMBARD
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State | IL
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Zip | 60148-4402
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Country | US
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Telephone | 855-528-8476
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Fax |
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Provider Business Mailing Address
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Address Line | 1616 GROVE COURT
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City | LOCKPORT
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State | IL
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Zip | 60441-4799
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Country | US
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Telephone | 779-875-1357
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-75575
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License Number State | IL
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