Provider Demographics
NPI:1104164730
Name:IWONA KONCZAK, PSY.D., CORP
Entity type:Organization
Organization Name:IWONA KONCZAK, PSY.D., CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IWONA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-226-1810
Mailing Address - Street 1:415 W GOLF RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3929
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 W GOLF RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3929
Practice Address - Country:US
Practice Address - Phone:847-226-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty