Healthcare Provider Details

I. General information

NPI: 1447377023
Provider Name (Legal Business Name): KOZIOL PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N WILKE RD SUITE 160
ARLINGTON HTS IL
60004-1278
US

IV. Provider business mailing address

PO BOX 1457
PALATINE IL
60078-1457
US

V. Phone/Fax

Practice location:
  • Phone: 847-686-3643
  • Fax:
Mailing address:
  • Phone: 847-686-3643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. LEONARD KOZIOL
Title or Position: OWNER
Credential: PSYD
Phone: 847-686-3643