Provider Demographics
NPI:1215355276
Name:RAKOCZY, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:RAKOCZY
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 1:1095 PINGREE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1727
Mailing Address - Country:US
Mailing Address - Phone:815-893-9040
Mailing Address - Fax:
Practice Address - Street 1:1095 PINGREE RD STE 202
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1727
Practice Address - Country:US
Practice Address - Phone:815-893-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-06
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490133271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical