MEDICARE: AUGUST J CWIK PSY D LTD

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1245853308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUGUST J CWIK PSY D LTD

Provider Business Mailing Address
First Line	:	2800 N LAKE SHORE DR APT 3017
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-6275
Country	:	US
Telephone Number	:	847-502-6308
Fax Number	:	773-857-7041

Provider Business Practice Location Address
First Line	:	30 N MICHIGAN AVE STE 1900
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-3624
Country	:	US
Telephone Number	:	312-346-6638
Fax Number	:	773-857-7041

Authorized Official
Title or Position	:	OWNER/PSYCHOLOGIST
Name	:	DR. AUGUST J CWIK
Credential	:	PSY.D.
Telephone Number	:	847-502-6308

Provider Enumeration Date	:	05/24/2020
Last Update Date	:	05/24/2020

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