Individual
DR. JEFFREY DAVID KAZMIERCZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
19 HERITAGE PLZ, SUITE 211, BOURBONNAIS, IL 60914-1369
(815) 933-8760
(815) 933-9061
Mailing address
19 HERITAGE PLZ, SUITE 211, BOURBONNAIS, IL 60914-1369
(815) 933-8760
(815) 933-9061
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
071008293
IL
103TA0700X
Adult Development & Aging Psychologist
—
—
103TC0700X
Clinical Psychologist
071008293
IL
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0200X
Forensic Psychologist
071008293
IL
103TR0400X
Rehabilitation Psychologist
—
—
Other
Enumeration date
02/04/2012
Last updated
04/09/2012
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