Healthcare Provider Details

I. General information

NPI: 1245379809
Provider Name (Legal Business Name): WILLA J KOZLOWSKI LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 W. 94TH TERRRACE SUITE 204
PRAIRIE VILLAGE KS
66207
US

IV. Provider business mailing address

5350 W 94TH TER SUITE 204
PRAIRIE VILLAGE KS
66207-2504
US

V. Phone/Fax

Practice location:
  • Phone: 913-261-9086
  • Fax: 913-273-0944
Mailing address:
  • Phone: 913-261-9086
  • Fax: 913-273-0944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2246
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2187
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: