Individual
JOANNA TKACZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGENT
Contact information
Practice address
5304 S MELVINA AVE, CHICAGO, IL 60638-2618
(773) 581-1698
Mailing address
5304 S MELVINA AVE, CHICAGO, IL 60638-2618
(773) 581-1698
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
ACC/HEALTH
IL
171W00000X
Contractor
Primary
ACC/HEALTH--11/09/06
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17
OTHER SERVICE PROVIDERS
IL
Enumeration date
04/17/2008
Last updated
04/17/2008
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