Provider Demographics
NPI:1528634136
Name:SIENKIEWICZ, STEPHANIE (LSW, COTA/L)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SIENKIEWICZ
Suffix:
Gender:F
Credentials:LSW, COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27W031 NORTH AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5122
Mailing Address - Country:US
Mailing Address - Phone:630-231-7166
Mailing Address - Fax:
Practice Address - Street 1:27W031 NORTH AVE STE 5
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-5122
Practice Address - Country:US
Practice Address - Phone:630-231-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005176224Z00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty