Healthcare Provider Details

I. General information

NPI: 1639392525
Provider Name (Legal Business Name): LINDA KOZLER LMSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 MILL ST
PLYMOUTH MI
48170
US

IV. Provider business mailing address

8990 HIX RD
LIVONIA MI
48150-3474
US

V. Phone/Fax

Practice location:
  • Phone: 734-776-2241
  • Fax:
Mailing address:
  • Phone: 734-464-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801084811
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: