Individual
DR. JACALYN ANNE BOSSEN KAWIECKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MHA
Contact information
Practice address
1412 W 4TH ST, RED WING HEALTHCARE COMMUNITY, RED WING, MN 55066-2107
(651) 388-2843
(651) 388-9502
Mailing address
6235 WENTWORTH AVE, J.A.B. KAWIECKI, INC.; D.B.A. EXCEL REHABILITATION, RICHFIELD, MN 55423-1540
(612) 481-1233
(612) 886-3231
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
42926
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206922900
—
MN
05
—
34247000
—
WI
01
—
611855422B159
TRICARE
—
01
—
81Q7G72KA
BCBS MINNESOTA
MN
01
—
963371033094
PREFERRED ONE
—
01
—
HP37218
HEALTH PARTNERS
—
Enumeration date
05/04/2006
Last updated
09/06/2013
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