Healthcare Provider Details

I. General information

NPI: 1912448614
Provider Name (Legal Business Name): KAMILA KOZICKI-BONNERT M.H.S.-CCC/SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KAMILA KOZICKI

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 N MERRILL ST
PARK RIDGE IL
60068-2746
US

IV. Provider business mailing address

888 N MERRILL ST
PARK RIDGE IL
60068-2746
US

V. Phone/Fax

Practice location:
  • Phone: 847-778-6985
  • Fax:
Mailing address:
  • Phone: 847-778-6985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146008081
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: