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Individual
SUSAN FECZKO
Active
Individual
SUSAN FECZKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
STA
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
2355S0801X
Speech-Language Assistant
217000074
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103034
—
IL
Enumeration date
03/16/2007
Last updated
08/06/2014
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