Provider Demographics
NPI:1558036756
Name:USCINSKI, ANITA (RDH BS)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:USCINSKI
Suffix:
Gender:F
Credentials:RDH BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13650 S ERIN DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8107
Mailing Address - Country:US
Mailing Address - Phone:773-653-6235
Mailing Address - Fax:
Practice Address - Street 1:6941 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2330
Practice Address - Country:US
Practice Address - Phone:773-586-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020014427174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty