Healthcare Provider Details

I. General information

NPI: 1366057044
Provider Name (Legal Business Name): HANIA JAKSZUK BRANDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANIA JAKSZUK

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N KENSINGTON AVE
LA GRANGE PARK IL
60526-1870
US

IV. Provider business mailing address

733 S VAIL AVE
ARLINGTON HEIGHTS IL
60005-2537
US

V. Phone/Fax

Practice location:
  • Phone: 312-965-2997
  • Fax:
Mailing address:
  • Phone: 847-293-7478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: