MEDICARE: AUTUMN KULCHAWIK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1700333903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN KULCHAWIK

Provider Business Mailing Address
First Line	:	1210 LAKE SUPERIOR RD APT 108
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-6742
Country	:	US
Telephone Number	:	602-919-1845
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 STEBBINGS CT STE 1
Second Line	:
City	:	BRADLEY
State	:	IL
Zip	:	60915-1282
Country	:	US
Telephone Number	:	602-919-1845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	08/13/2022

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Directions to “ AUTUMN KULCHAWIK ” Practice Location

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