Provider Demographics
NPI:1275076788
Name:GWOZDZ, ANNETTE (ATC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:GWOZDZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:GULSETH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:167 LAKESIDE DR
Mailing Address - Street 2:APT 1531
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-7946
Mailing Address - Country:US
Mailing Address - Phone:847-807-9521
Mailing Address - Fax:
Practice Address - Street 1:1221 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1404
Practice Address - Country:US
Practice Address - Phone:630-264-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0037722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer