Doctor Name: | MS. NICOLE ROMANA KOSTAKEN |
NPI Number: | 1023258449 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 178005304 |
Business Practice Address: | 9021 Ogden Ave Brookfield, IL - 60513 |
Business Phone Number: | 7083544547 |
Business Fax Number: | |
Mailing Address: | 9021 Ogden Ave, BROOKFIELD |
State: | IL |
Postal Code: | 605132040 |
Phone Number: | 7083544547 |
Fax Number: | |
NPI Enumeration Date: | 02/25/2009 |
NPI Last Update Date: | 02/25/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 178005304 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |