Healthcare Provider Details

I. General information

NPI: 1104669787
Provider Name (Legal Business Name): GABRIELA VICTORIA KUDERSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 QUADRANGLE DR STE C
BOLINGBROOK IL
60440-3455
US

IV. Provider business mailing address

405 CENTRAL AVE
NORTHFIELD IL
60093-3006
US

V. Phone/Fax

Practice location:
  • Phone: 331-452-6419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.117491
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: