Provider Demographics
NPI:1962870543
Name:KWIATKOWSKI, MARGARET
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:KWIATKOWSKI
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 1:519 RUE CHAMONIX
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3710
Mailing Address - Country:US
Mailing Address - Phone:630-620-9440
Mailing Address - Fax:630-620-6540
Practice Address - Street 1:721 W LAKE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2035
Practice Address - Country:US
Practice Address - Phone:630-620-9440
Practice Address - Fax:630-620-9540
Is Sole Proprietor?:No
Enumeration Date:2015-09-12
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178001046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional