Healthcare Provider Details

I. General information

NPI: 1427118637
Provider Name (Legal Business Name): DEBORAH KOZLOWSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2683 US HIGHWAY 34
OSWEGO IL
60543
US

IV. Provider business mailing address

2683 US HIGHWAY 34
OSWEGO IL
60543
US

V. Phone/Fax

Practice location:
  • Phone: 630-551-8602
  • Fax: 630-701-2928
Mailing address:
  • Phone: 630-544-8104
  • Fax: 630-701-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149008780
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: