Provider Demographics
NPI:1396914982
Name:KOLODZIEJSKI, VICTORIA PATRICE
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:PATRICE
Last Name:KOLODZIEJSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:PATRICE
Other - Last Name:HEETHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1728 W PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2130
Mailing Address - Country:US
Mailing Address - Phone:773-517-5523
Mailing Address - Fax:
Practice Address - Street 1:5820 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2616
Practice Address - Country:US
Practice Address - Phone:773-517-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist