Provider Demographics
NPI:1215644653
Name:ANTKIEWICZ, KACI LILLIAN
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:LILLIAN
Last Name:ANTKIEWICZ
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 1:1358 W GREENLEAF AVE APT GS
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-6017
Mailing Address - Country:US
Mailing Address - Phone:708-606-4256
Mailing Address - Fax:
Practice Address - Street 1:1358 W GREENLEAF AVE APT GS
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-6017
Practice Address - Country:US
Practice Address - Phone:708-606-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist