Provider Demographics
NPI:1851868004
Name:BERKOWICZ, JACQUELINE (LAC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BERKOWICZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ZAHAVA
Other - Middle Name:
Other - Last Name:BERKOWICZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:3844 SUGAR LOAF LN
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1922
Mailing Address - Country:US
Mailing Address - Phone:201-638-2271
Mailing Address - Fax:
Practice Address - Street 1:3844 SUGAR LOAF LN
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1922
Practice Address - Country:US
Practice Address - Phone:201-638-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001433171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist