MEDICARE: JOANNE RATKOWSKI, SC

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	071006837	IL

General Provider Information

NPI Number	:	1770885477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNE RATKOWSKI, SC

Provider Business Mailing Address
First Line	:	1219 N NOBLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-3377
Country	:	US
Telephone Number	:	773-720-2781
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 N NOBLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-3377
Country	:	US
Telephone Number	:	773-720-2781
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. JOANNE RATKOWSKI
Credential	:
Telephone Number	:	773-720-2781

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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