Provider Demographics
NPI:1285776997
Name:OLESZEK, MARY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:OLESZEK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W LAKE ST
Mailing Address - Street 2:APT 6L
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1710
Mailing Address - Country:US
Mailing Address - Phone:847-967-5100
Mailing Address - Fax:847-967-5180
Practice Address - Street 1:8950 GROSS POINT RD
Practice Address - Street 2:SUITE D
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1860
Practice Address - Country:US
Practice Address - Phone:847-967-5100
Practice Address - Fax:847-967-5180
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist