Provider Demographics
NPI:1871773416
Name:KULZAK-TAYLOR, DONNA JEAN (NCMMT,LMT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JEAN
Last Name:KULZAK-TAYLOR
Suffix:
Gender:F
Credentials:NCMMT,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 RAVINE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7645
Mailing Address - Country:US
Mailing Address - Phone:847-724-4479
Mailing Address - Fax:847-998-6916
Practice Address - Street 1:2401 RAVINE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7645
Practice Address - Country:US
Practice Address - Phone:847-724-4479
Practice Address - Fax:847-998-6916
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist