Provider Demographics
NPI:1194126409
Name:KUCZAJ, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KUCZAJ
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 1:6619 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-1752
Mailing Address - Country:US
Mailing Address - Phone:630-338-3682
Mailing Address - Fax:
Practice Address - Street 1:4413 ROOSEVELT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-2074
Practice Address - Country:US
Practice Address - Phone:708-449-5900
Practice Address - Fax:708-499-5901
Is Sole Proprietor?:No
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.014074225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist