Provider Demographics
NPI:1295961886
Name:KOKALJ, ANTHONY RAYMOND (MA)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:RAYMOND
Last Name:KOKALJ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123W WASHINGTON ST 321
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8297
Mailing Address - Country:US
Mailing Address - Phone:630-383-2077
Mailing Address - Fax:815-725-8144
Practice Address - Street 1:123W WASHINGTON ST 321
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8297
Practice Address - Country:US
Practice Address - Phone:630-383-2077
Practice Address - Fax:815-725-8144
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health