Provider Demographics
NPI:1588890222
Name:BALICKI, SHARON ELIZABETH (ATC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ELIZABETH
Last Name:BALICKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:WIORKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 GOODWIN PL
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1805
Mailing Address - Country:US
Mailing Address - Phone:847-566-1242
Mailing Address - Fax:
Practice Address - Street 1:404 MCHENRY RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6740
Practice Address - Country:US
Practice Address - Phone:847-285-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-0015112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer