Healthcare Provider Details

I. General information

NPI: 1043765308
Provider Name (Legal Business Name): IWONA SZUKIELOJC-KIZZIAH B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 CAMINO REAL STE 404
BOCA RATON FL
33433-5510
US

IV. Provider business mailing address

6344 HATTERAS CLUB DR
LAKE WORTH FL
33463-6541
US

V. Phone/Fax

Practice location:
  • Phone: 954-634-2344
  • Fax:
Mailing address:
  • Phone: 305-401-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: