Healthcare Provider Details

I. General information

NPI: 1508352113
Provider Name (Legal Business Name): KAITLIN MARIE KUZNIAR AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W TAYLOR ST # B-46
CHICAGO IL
60612-7242
US

IV. Provider business mailing address

1855 W TAYLOR ST # B-46
CHICAGO IL
60612-7242
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6522
  • Fax:
Mailing address:
  • Phone: 312-996-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.001668
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: