Provider Demographics
NPI:1902558083
Name:CISZEK, KRYSTYNA (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:KRYSTYNA
Middle Name:
Last Name:CISZEK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 N MONITOR AVE APT SUITE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5247
Mailing Address - Country:US
Mailing Address - Phone:773-610-5370
Mailing Address - Fax:
Practice Address - Street 1:3020 N MONITOR AVE APT SUITE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5247
Practice Address - Country:US
Practice Address - Phone:773-610-5370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-21-57034103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst