Provider Demographics
NPI:1841412822
Name:VUCKOVICH, MARIANNE P (RKT)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:P
Last Name:VUCKOVICH
Suffix:
Gender:F
Credentials:RKT
Other - Prefix:MS
Other - First Name:MARIANNE
Other - Middle Name:P
Other - Last Name:EMICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RKT
Mailing Address - Street 1:333 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3328
Mailing Address - Country:US
Mailing Address - Phone:847-945-4845
Mailing Address - Fax:847-945-4893
Practice Address - Street 1:1044 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1282
Practice Address - Country:US
Practice Address - Phone:847-234-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1070226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist