MEDICARE: EMMA GRACE OLSZOWKA

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1336973684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA GRACE OLSZOWKA

Provider Business Mailing Address
First Line	:	2220 CHURCH ST
Second Line	:
City	:	JOHNSBURG
State	:	IL
Zip	:	60051-5910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 CHURCH ST
Second Line	:
City	:	JOHNSBURG
State	:	IL
Zip	:	60051-5910
Country	:	US
Telephone Number	:	815-385-6210
Fax Number	:

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

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	08/29/2024

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Directions to “ EMMA GRACE OLSZOWKA ” Practice Location

Language	Start Address	Practice Location

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