Provider Demographics
NPI:1245649243
Name:KUCZEWSKI, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KUCZEWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LAMB ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4206
Mailing Address - Country:US
Mailing Address - Phone:207-591-4136
Mailing Address - Fax:207-591-4138
Practice Address - Street 1:11 MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4786
Practice Address - Country:US
Practice Address - Phone:207-591-4136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDL402237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist