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General NPI Number Information
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NPI Number | 1245695022
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Entity Type | Organization
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Legal Business Name | CAITLIN KOZICKI LLC
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 7220 W JEFFERSON AVE STE 218
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City | LAKEWOOD
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State | CO
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Zip | 80235-2058
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Country | US
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Telephone | 303-957-6504
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Fax |
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Provider Business Mailing Address
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Address Line | 7220 W JEFFERSON AVE STE 218
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City | LAKEWOOD
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State | CO
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Zip | 80235-2058
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Country | US
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Telephone | 303-957-6504
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CAITLIN KOZICKI
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Credential |
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Telephone | 303-957-6504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 5209
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License Number State | CO
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