Healthcare Provider Details

I. General information

NPI: 1124814108
Provider Name (Legal Business Name): KELLY RYAN KOZLOWSKI MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38345 30TH ST E STE C2
PALMDALE CA
93550-4982
US

IV. Provider business mailing address

38345 30TH ST E STE C2
PALMDALE CA
93550-4982
US

V. Phone/Fax

Practice location:
  • Phone: 661-418-2871
  • Fax:
Mailing address:
  • Phone: 661-418-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: