Healthcare Provider Details

I. General information

NPI: 1851431498
Provider Name (Legal Business Name): KRISTEN KOLZOW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 BOYS REPUBLIC DR
CHINO HILLS CA
91709-5447
US

IV. Provider business mailing address

1907 BOYS REPUBLIC DR
CHINO HILLS CA
91709-5447
US

V. Phone/Fax

Practice location:
  • Phone: 909-628-1217
  • Fax: 909-993-1106
Mailing address:
  • Phone: 909-628-1217
  • Fax: 909-993-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 24524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: