Provider Demographics
NPI:1528675758
Name:RYCHTARCZYK, ANETA MARZENA (SLP)
Entity type:Individual
Prefix:
First Name:ANETA
Middle Name:MARZENA
Last Name:RYCHTARCZYK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3116
Mailing Address - Country:US
Mailing Address - Phone:708-248-3512
Mailing Address - Fax:
Practice Address - Street 1:5222 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6330
Practice Address - Country:US
Practice Address - Phone:815-654-4960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146015356235Z00000X
IL242005445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist