Provider Demographics
NPI:1699453852
Name:MALINOWSKI, ERIN
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:MALINOWSKI
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 1:453 W OTTO DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3167
Mailing Address - Country:US
Mailing Address - Phone:815-530-3906
Mailing Address - Fax:815-476-7361
Practice Address - Street 1:1197 S BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-1616
Practice Address - Country:US
Practice Address - Phone:815-476-5405
Practice Address - Fax:815-476-7361
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106E00000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst