Healthcare Provider Details

I. General information

NPI: 1851502553
Provider Name (Legal Business Name): JENNIFER LYNNE KOZLOWSKI BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 E 13 MILE RD SUITE 300
WARREN MI
48093-5000
US

IV. Provider business mailing address

42116 UTAH DR
STERLING HEIGHTS MI
48313-2984
US

V. Phone/Fax

Practice location:
  • Phone: 586-258-0206
  • Fax: 586-258-0201
Mailing address:
  • Phone: 586-258-0206
  • Fax: 586-258-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: