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General NPI Number Information
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NPI Number | 1861983181
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Entity Type | Individual
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Provider Name | MALLORY GIZOWSKI
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Gender | Female
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 2400 N SHEFFIELD AVE
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City | CHICAGO
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State | IL
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Zip | 60614-3936
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Country | US
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Telephone | 312-362-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 52 W REDHEAD CT
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City | ROUND LAKE BEACH
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State | IL
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Zip | 60073-4946
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Country | US
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Telephone | 847-494-3642
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | IL
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