Provider Demographics
NPI:1194294843
Name:SLOWIK-ROSZKOWSKI, PATRYCJA MONIKA (RBT-76-1487)
Entity type:Individual
Prefix:
First Name:PATRYCJA
Middle Name:MONIKA
Last Name:SLOWIK-ROSZKOWSKI
Suffix:
Gender:F
Credentials:RBT-76-1487
Other - Prefix:
Other - First Name:PATRYCJA
Other - Middle Name:MONIKA
Other - Last Name:SLOWIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3851 N PARIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2043
Mailing Address - Country:US
Mailing Address - Phone:773-954-5245
Mailing Address - Fax:
Practice Address - Street 1:3851 N PARIS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2043
Practice Address - Country:US
Practice Address - Phone:773-954-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL761487106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician