1861793283 NPI number — MRS. JILL SPENCER KACZOR M.S.W.

Table of content: MRS. JILL SPENCER KACZOR M.S.W. (NPI 1861793283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861793283 NPI number — MRS. JILL SPENCER KACZOR M.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KACZOR
Provider First Name:
JILL
Provider Middle Name:
SPENCER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W.
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:
1861793283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 W BIG BEAVER RD STE 200
Provider Second Line Business Mailing Address:
PMB 17107998
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-220-6881
Provider Business Mailing Address Fax Number:
248-654-0200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W BIG BEAVER RD STE 200
Provider Second Line Business Practice Location Address:
PMB 17107998
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48084-5283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-220-6881
Provider Business Practice Location Address Fax Number:
248-654-0200
Provider Enumeration Date:
11/17/2010

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: 1041C0700X , with the licence number:  6801092174 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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