Healthcare Provider Details

I. General information

NPI: 1821727033
Provider Name (Legal Business Name): ASHLEY ROSE KOZMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 S PORTAGE PATH
AKRON OH
44320-2326
US

IV. Provider business mailing address

380 S PORTAGE PATH
AKRON OH
44320-2326
US

V. Phone/Fax

Practice location:
  • Phone: 330-315-4901
  • Fax:
Mailing address:
  • Phone: 330-315-4901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number178973
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: