Provider Demographics
NPI:1386906261
Name:KAZ COMMUNITY DEVELPOMENT
Entity type:Organization
Organization Name:KAZ COMMUNITY DEVELPOMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:773-936-7000
Mailing Address - Street 1:12654 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-1904
Mailing Address - Country:US
Mailing Address - Phone:708-489-0001
Mailing Address - Fax:708-489-0002
Practice Address - Street 1:12654 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-1904
Practice Address - Country:US
Practice Address - Phone:708-489-0001
Practice Address - Fax:708-489-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty