Healthcare Provider Details

I. General information

NPI: 1841655529
Provider Name (Legal Business Name): LAURA KOZIEJ MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ROOSEVELT RD
GLEN ELLYN IL
60137-5806
US

IV. Provider business mailing address

4550 N LAPORTE AVE
CHICAGO IL
60630-3916
US

V. Phone/Fax

Practice location:
  • Phone: 163-098-4220
  • Fax: 630-984-2051
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178011595
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: