Healthcare Provider Details

I. General information

NPI: 1083866271
Provider Name (Legal Business Name): DAVID MICHAEL KOZLOWSKI MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9263 REDWOOD RD STE 8
WEST JORDAN UT
84088-6571
US

IV. Provider business mailing address

9263 REDWOOD RD. STE. 8
WEST JORDAN UT
84088
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-0749
  • Fax:
Mailing address:
  • Phone: 801-566-0749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6972251-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: