Provider Demographics
NPI:1457580037
Name:JOANNA BURG TOZEWSKI, LLC
Entity type:Organization
Organization Name:JOANNA BURG TOZEWSKI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:BURG
Authorized Official - Last Name:TORZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-863-6393
Mailing Address - Street 1:25 E WASHINGTON ST
Mailing Address - Street 2:SUITE 1117
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1708
Mailing Address - Country:US
Mailing Address - Phone:312-863-6393
Mailing Address - Fax:312-863-6392
Practice Address - Street 1:25 E WASHINGTON ST
Practice Address - Street 2:SUITE 1117
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:312-863-6393
Practice Address - Fax:312-863-6392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-05
Last Update Date:2009-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005730261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health