Healthcare Provider Details

I. General information

NPI: 1750929329
Provider Name (Legal Business Name): SARAH KOZIOL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2019
Last Update Date: 12/14/2019
Certification Date: 12/14/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10699 MELODY DR STE 2
NORTHGLENN CO
80234-4131
US

IV. Provider business mailing address

5409 S FORESTHILL ST
LITTLETON CO
80120-1339
US

V. Phone/Fax

Practice location:
  • Phone: 303-252-4179
  • Fax: 303-252-4186
Mailing address:
  • Phone: 720-496-7368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberNLC.0109669
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: