Provider Demographics
NPI:1174370316
Name:RAFACZ, MARIA STANISLAWA
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:STANISLAWA
Last Name:RAFACZ
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 1:411 E IVY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-2566
Mailing Address - Country:US
Mailing Address - Phone:708-263-5764
Mailing Address - Fax:
Practice Address - Street 1:411 E IVY LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-2566
Practice Address - Country:US
Practice Address - Phone:708-263-5764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL217.0004832355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant