1598934234 NPI number — MRS. AGNIESZKA SOBECKA DEVELOP THERAPIST

Table of content: MRS. AGNIESZKA SOBECKA DEVELOP THERAPIST (NPI 1598934234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598934234 NPI number — MRS. AGNIESZKA SOBECKA DEVELOP THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOBECKA
Provider First Name:
AGNIESZKA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DEVELOP THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598934234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
64 W 64TH ST
Provider Second Line Business Mailing Address:
#201
Provider Business Mailing Address City Name:
WESTMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60559-3121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-795-1672
Provider Business Mailing Address Fax Number:
815-730-1818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
857 CENTER CT
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SHOREWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60404-8519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-730-1818
Provider Business Practice Location Address Fax Number:
815-730-0808
Provider Enumeration Date:
02/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  AS90850901P , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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