Healthcare Provider Details

I. General information

NPI: 1770257107
Provider Name (Legal Business Name): JESSICA KRUSZECKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WILLOW ST
FRANKFORT IL
60423-1140
US

IV. Provider business mailing address

17055 SWALLOW LN
ORLAND PARK IL
60467-8496
US

V. Phone/Fax

Practice location:
  • Phone: 815-806-4600
  • Fax:
Mailing address:
  • Phone: 708-528-2806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.014223
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: