Individual
MARY C WISNIEWSKI
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
5530 S ELLIS AVE, CHICAGO, IL 60637-1402
(773) 753-4708
(773) 834-4470
Mailing address
5457 S KENWOOD AVE, CHICAGO, IL 60615-5312
(773) 288-0612
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
03/10/2006
Last updated
07/08/2007
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