Provider Demographics
NPI:1609915933
Name:SUCHECKI, DONNA KOWALCZYK (LMT, BCTMB)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:KOWALCZYK
Last Name:SUCHECKI
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:KOWALCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, BCTMB
Mailing Address - Street 1:7409 WOODRIDGE DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517
Mailing Address - Country:US
Mailing Address - Phone:773-895-2211
Mailing Address - Fax:
Practice Address - Street 1:7409 WOODRIDGE DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517
Practice Address - Country:US
Practice Address - Phone:773-895-2211
Practice Address - Fax:773-529-0685
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227004032225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist