Doctor Name: | MS. AGNIESZKA ALINA WYSOCKA |
NPI Number: | 1043685589 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 180005556 |
Business Practice Address: | 4419 W North Ave Melrose Park, IL - 601601021 |
Business Phone Number: | 7737777112 |
Business Fax Number: | 7085477732 |
Mailing Address: | 2010 Hassell Rd, Apt #201 HOFFMAN ESTATES |
State: | IL |
Postal Code: | 601696340 |
Phone Number: | 8479222210 |
Fax Number: | |
NPI Enumeration Date: | 12/09/2015 |
NPI Last Update Date: | 12/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180005556 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |