Provider Demographics
NPI:1558816371
Name:SHALAYSKA, OLESIA
Entity type:Individual
Prefix:
First Name:OLESIA
Middle Name:
Last Name:SHALAYSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BASSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2111
Mailing Address - Country:US
Mailing Address - Phone:630-536-9444
Mailing Address - Fax:
Practice Address - Street 1:4N701 SCHOOL RD STE A
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175
Practice Address - Country:US
Practice Address - Phone:630-549-6497
Practice Address - Fax:630-549-0942
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042972A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical