MEDICARE: JENNIFER KUSTANOVICH-HOZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	18544	SC

General Provider Information

NPI Number	:	1033067533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KUSTANOVICH-HOZA

Provider Business Mailing Address
First Line	:	327 STRAIGHTAWAY LN
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-7102
Country	:	US
Telephone Number	:	347-585-8833
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 STRAIGHTAWAY LN
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-7102
Country	:	US
Telephone Number	:	347-585-8833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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