Mariana Polistchuk, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

242003966 Issued in IL

Practice address

1238 Regent Dr
Mundelein, IL 60060-2062

Phone

(224) 392-8707

NPI assigned

Aug 27, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Functional Speech Therapy Co.

  • Speech-Language Pathologist
  • Mundelein, IL
  • NPI 1811582430
  NPD Authorized official
• Functional Speech Therapy Services

  • Speech-Language Pathologist
  • Salisbury, NC
  • NPI 1710025473
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614902400000",
    "number": "1023564432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1238 REGENT DR",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600602062",
            "telephone_number": "224-392-8707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1238 REGENT DR",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600602062",
            "telephone_number": "224-392-8707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLISTCHUK",
        "first_name": "MARIANA",
        "name_prefix": "Mrs.",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-27",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242003966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Peterson, RPH
• Jennifer Marie Philbrick, M.ED.
• Susan Kagen Podell, MS
• Thomas W Pogue
• Timothy Joseph Poland, MD
• Thomas C Pomierski
• Marianna Poplavsky, PHARMD
• Prime Health Care, LTD
• Provida Medical Supply, Inc.
• Katelyn Punches, RDN, LDN

• Speech-Language Pathologist in Mundelein, IL
• Providers in Mundelein, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.