Healthcare Provider Details

I. General information

NPI: 1346930211
Provider Name (Legal Business Name): MICHAELA KOZLOWSKI-MCKINLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20971 E SMOKY HILL RD
CENTENNIAL CO
80015-5186
US

IV. Provider business mailing address

20971 E SMOKY HILL RD
CENTENNIAL CO
80015-5186
US

V. Phone/Fax

Practice location:
  • Phone: 720-961-8539
  • Fax:
Mailing address:
  • Phone: 720-961-8539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: