Healthcare Provider Details

I. General information

NPI: 1366425407
Provider Name (Legal Business Name): JULIE A KOZLOW RSWT CPS CCJP CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E STATE ST
STERLING MI
48659-9548
US

IV. Provider business mailing address

PO BOX 40
NATIONAL CITY MI
48748-0040
US

V. Phone/Fax

Practice location:
  • Phone: 989-654-3501
  • Fax: 989-524-3788
Mailing address:
  • Phone: 989-240-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6803084632
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: