Healthcare Provider Details

I. General information

NPI: 1871773416
Provider Name (Legal Business Name): DONNA JEAN KULZAK-TAYLOR NCMMT,LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 RAVINE WAY SUITE 100
GLENVIEW IL
60025-7645
US

IV. Provider business mailing address

2350 RAVINE WAY STE 600
GLENVIEW IL
60025-7657
US

V. Phone/Fax

Practice location:
  • Phone: 847-724-4479
  • Fax: 847-998-6916
Mailing address:
  • Phone: 847-324-3020
  • Fax: 847-998-9693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: