Healthcare Provider Details

I. General information

NPI: 1124719661
Provider Name (Legal Business Name): DIANA RENEE CZECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MARTIN AVE
NAPERVILLE IL
60540-6536
US

IV. Provider business mailing address

507 WILCOX ST APT 2
JOLIET IL
60435-6143
US

V. Phone/Fax

Practice location:
  • Phone: 630-848-1200
  • Fax: 630-848-1208
Mailing address:
  • Phone: 773-668-7943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.107537
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: