Provider Demographics
NPI:1124719661
Name:CZECH, DIANA RENEE
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:RENEE
Last Name:CZECH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 WILCOX ST APT 2
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6143
Mailing Address - Country:US
Mailing Address - Phone:773-668-7943
Mailing Address - Fax:
Practice Address - Street 1:1112 S WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7960
Practice Address - Country:US
Practice Address - Phone:630-848-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.107537104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker