Provider Demographics
NPI:1063789378
Name:NATALINO-CZOSNYKA, LAURA R (MHS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:NATALINO-CZOSNYKA
Suffix:
Gender:F
Credentials:MHS CCC-SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:R
Other - Last Name:NATALINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-0172
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:190 S PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3271
Practice Address - Country:US
Practice Address - Phone:630-617-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242001792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist