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Organization

JEFF D. KAZMIERCZAK, PSY.D., P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JEFFREY DAVID KAZMIERCZAK PSY.D. (PSYCHOLOGIST)
(773) 412-2778
Entity
Organization

Contact information

Practice address
19 HERITAGE DR, SUITE 211, BOURBONNAIS, IL 60914-1369
(815) 933-8760
(815) 933-9061
Mailing address
2626 FLOSSMOOR RD, 2E, FLOSSMOOR, IL 60422-1555
(773) 412-2778

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
103TA0700X
Adult Development & Aging Psychologist
103TC0700X
Clinical Psychologist
103TC1900X
Counseling Psychologist
103TC2200X
Clinical Child & Adolescent Psychologist
103TR0400X
Rehabilitation Psychologist
071008293
IL

Other

Enumeration date
04/09/2012
Last updated
11/15/2012
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