MEDICARE: MRS. ELIZABETH ANN HEIDT KOZISEK PH D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	451	NE
2	103T00000X	Psychologist	451	NE

General Provider Information

NPI Number	:	1336187905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANN HEIDT KOZISEK PH D

Provider Business Mailing Address
First Line	:	106 EAGLE RD
Second Line	:
City	:	SAINT LIBORY
State	:	NE
Zip	:	68872-2801
Country	:	US
Telephone Number	:	308-379-1949
Fax Number	:	308-687-6309

Provider Business Practice Location Address
First Line	:	106 EAGLE RD
Second Line	:
City	:	SAINT LIBORY
State	:	NE
Zip	:	68872-2801
Country	:	US
Telephone Number	:	308-379-1949
Fax Number	:	308-687-6309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	01/07/2026

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