Healthcare Provider Details

I. General information

NPI: 1568674802
Provider Name (Legal Business Name): KAREN LYNN KOZARA MA, CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 S MILFORD RD
HIGHLAND MI
48357-4938
US

IV. Provider business mailing address

725 HILLCREST CIR APT 203
AUBURN HILLS MI
48326-4539
US

V. Phone/Fax

Practice location:
  • Phone: 248-684-9610
  • Fax: 248-684-9611
Mailing address:
  • Phone: 248-765-7039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01101919
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: