1801165923 NPI number — MISS JESSICA LAUREN KRAWCZYK M.A.

Table of content: MISS JESSICA LAUREN KRAWCZYK M.A. (NPI 1801165923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801165923 NPI number — MISS JESSICA LAUREN KRAWCZYK M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAWCZYK
Provider First Name:
JESSICA
Provider Middle Name:
LAUREN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801165923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 S QUENTIN RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
PALATINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60067-6778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-359-7490
Provider Business Mailing Address Fax Number:
847-359-7525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 S QUENTIN RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
PALATINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60067-6778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-359-7490
Provider Business Practice Location Address Fax Number:
847-359-7525
Provider Enumeration Date:
12/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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