Provider Demographics
NPI:1609281385
Name:KUCERA, DIANNA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:L
Last Name:KUCERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 S HIGHLAND AVE STE 300-10
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4766
Mailing Address - Country:US
Mailing Address - Phone:630-792-1343
Mailing Address - Fax:630-576-5553
Practice Address - Street 1:1920 S HIGHLAND AVE STE 300-10
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4766
Practice Address - Country:US
Practice Address - Phone:630-792-1343
Practice Address - Fax:630-576-5553
Is Sole Proprietor?:No
Enumeration Date:2014-06-21
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-008246103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical