Healthcare Provider Details

I. General information

NPI: 1972828200
Provider Name (Legal Business Name): AMY KOZIARSKI LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/08/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 MONROE ST STE H2
SYLVANIA OH
43560-2260
US

IV. Provider business mailing address

5800 MONROE ST STE H2
SYLVANIA OH
43560-2260
US

V. Phone/Fax

Practice location:
  • Phone: 419-343-7737
  • Fax: 567-249-0114
Mailing address:
  • Phone: 419-343-7737
  • Fax: 567-249-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI 1000016
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: