Provider Demographics
NPI:1922440528
Name:KOLACZ, JOLANTA (DT)
Entity Type:Individual
Prefix:
First Name:JOLANTA
Middle Name:
Last Name:KOLACZ
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 ABBOTSFORD DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2089
Mailing Address - Country:US
Mailing Address - Phone:630-548-5051
Mailing Address - Fax:
Practice Address - Street 1:1535 ABBOTSFORD DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2089
Practice Address - Country:US
Practice Address - Phone:630-548-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist