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General NPI Number Information
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NPI Number | 1295803765
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Entity Type | Individual
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Provider Name | JILL GURWITZ KOZBERG M. A.
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 13100 WAYZATA BLVD SUITE 400
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City | MINNETONKA
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State | MN
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Zip | 55305-1802
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Country | US
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Telephone | 952-546-0616
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Fax | 952-593-1778
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Provider Business Mailing Address
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Address Line | 9901 SAINT JOHNS RD
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City | MINNETONKA
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State | MN
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Zip | 55305-4640
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Country | US
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Telephone | 952-936-0926
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Fax | 952-936-0927
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP3372
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LP3372
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License Number State | MN
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