Healthcare Provider Details

I. General information

NPI: 1447441605
Provider Name (Legal Business Name): AMANDA N KOZLOWSKI AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA N SNYDER AU.D.

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 HOSPITAL DR SUITE 200
GLEN BURNIE MD
21061-6904
US

IV. Provider business mailing address

203 HOSPITAL DR SUITE 200
GLEN BURNIE MD
21061-6904
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-8840
  • Fax: 410-760-8847
Mailing address:
  • Phone: 410-760-8840
  • Fax: 410-760-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01137
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: