| Amanda Gabrielle Kacena, Llc | |
|
2005 Valparaiso St Ste 106 Valparaiso IN 46383-3330 | |
| (312) 590-7140 | |
| Not Available |
| Full Name | Amanda Gabrielle Kacena, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2005 Valparaiso St Ste 106, Valparaiso, Indiana |
| Authorized Official Name and Position | Amanda Gabrielle Kacena (OWNER) |
| Authorized Official Contact | 3125907140 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amanda Gabrielle Kacena, Llc 4101 Brentwood Dr Valparaiso IN 46383-1373 Ph: (312) 590-7140 | Amanda Gabrielle Kacena, Llc 2005 Valparaiso St Ste 106 Valparaiso IN 46383-3330 Ph: (312) 590-7140 |
| NPI Number | 1104337195 |
|---|---|
| Provider Enumeration Date | 10/17/2017 |
| Last Update Date | 10/17/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104337195 | NPI | - | NPPES |
| 39001619A | Other | IN | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 39001619A (Indiana) | Primary |
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