Provider Demographics
NPI:1104323153
Name:WRONKIEWICZ, SARAH JANE (RBT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:WRONKIEWICZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 W IRVING PARK RD APT 208
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-1853
Mailing Address - Country:US
Mailing Address - Phone:708-309-0271
Mailing Address - Fax:
Practice Address - Street 1:926 W IRVING PARK RD APT 208
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-1853
Practice Address - Country:US
Practice Address - Phone:708-309-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18-52919106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician