Healthcare Provider Details

I. General information

NPI: 1417399650
Provider Name (Legal Business Name): KATLYNN KOZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 DEKALB PIKE
NORRISTOWN PA
19401-1820
US

IV. Provider business mailing address

2100 MACK BLVD 2ND FL
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 610-278-2834
  • Fax:
Mailing address:
  • Phone: 484-884-0183
  • Fax: 484-884-0628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: