Provider Demographics
NPI:1326256298
Name:KWIEK, ILONA H
Entity Type:Individual
Prefix:
First Name:ILONA
Middle Name:H
Last Name:KWIEK
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 1:4130 LINDOW DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5020
Mailing Address - Country:US
Mailing Address - Phone:586-465-4780
Mailing Address - Fax:586-465-4811
Practice Address - Street 1:277 N GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1546
Practice Address - Country:US
Practice Address - Phone:586-465-4780
Practice Address - Fax:586-465-4811
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health