Provider Demographics
NPI:1548801509
Name:SZLACHCIUK, ADRIANNA RAYN
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:RAYN
Last Name:SZLACHCIUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13132 WESTLAKE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2412
Mailing Address - Country:US
Mailing Address - Phone:909-994-1311
Mailing Address - Fax:
Practice Address - Street 1:13132 WESTLAKE ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2412
Practice Address - Country:US
Practice Address - Phone:909-994-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician