Healthcare Provider Details

I. General information

NPI: 1194945808
Provider Name (Legal Business Name): GWENN ALISON KOZLOW M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MICHIGAN ST NE SUITE 2000
GRAND RAPIDS MI
49503-2515
US

IV. Provider business mailing address

208 BELLE ST
KALAMAZOO MI
49009-5825
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-2700
  • Fax: 616-391-3114
Mailing address:
  • Phone: 269-217-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: