Healthcare Provider Details

I. General information

NPI: 1902956071
Provider Name (Legal Business Name): ELIZABETH KOZLOWSKI-KIES L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CAROLYN CT
LAKE ZURICH IL
60047-1506
US

IV. Provider business mailing address

28 CAROLYN CT
LAKE ZURICH IL
60047-1506
US

V. Phone/Fax

Practice location:
  • Phone: 847-550-9515
  • Fax:
Mailing address:
  • Phone: 847-550-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: