Provider Demographics
NPI:1144032525
Name:KLOSKI, BREANA A
Entity type:Individual
Prefix:
First Name:BREANA
Middle Name:A
Last Name:KLOSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5051
Mailing Address - Country:US
Mailing Address - Phone:574-303-8301
Mailing Address - Fax:
Practice Address - Street 1:405 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5051
Practice Address - Country:US
Practice Address - Phone:574-303-8301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist