MEDICARE: AGNIESZKA DOMINIKA LENART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1073968012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNIESZKA DOMINIKA LENART

Provider Business Mailing Address
First Line	:	7170 W GRAND AVE
Second Line	:	APT 4E
City	:	CHICAGO
State	:	IL
Zip	:	60707-2862
Country	:	US
Telephone Number	:	773-971-6277
Fax Number	:

Provider Business Practice Location Address
First Line	:	7170 W GRAND AVE
Second Line	:	APT 4E
City	:	CHICAGO
State	:	IL
Zip	:	60707-2862
Country	:	US
Telephone Number	:	773-971-6277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	04/27/2016

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