Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071009931 | IL |
Y | 103TC0700X | Clinical Psychologist | 071009931 | IL |
NPI | 1003375981 |
---|---|
Provider Name | Dr. Dominika Anne Winiarski |
First Address | Chicago, IL 60612-3706 |
Second Address | Chicago, IL 60612-3706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2019 |
Last Update Date | 22/03/2019 |