Individual
KATIE LYNN SPENCER LISKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(855) 692-8478
Mailing address
713 STRATFORD DR E, APT 12, BOURBONNAIS, IL 60914-1777
(906) 430-0208
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.0032998
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
PROVIDER TYPE 22
IL
Enumeration date
03/03/2015
Last updated
02/05/2016
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