Provider Demographics
NPI:1982047080
Name:WOJTKOWSKI, KRYSTYNA
Entity type:Individual
Prefix:
First Name:KRYSTYNA
Middle Name:
Last Name:WOJTKOWSKI
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 1:112 HEATHERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-4889
Mailing Address - Country:US
Mailing Address - Phone:224-875-0328
Mailing Address - Fax:
Practice Address - Street 1:112 HEATHERVIEW DR
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-4889
Practice Address - Country:US
Practice Address - Phone:224-875-0328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist