MEDICARE: JULIE A KOZLOW RSWT CPS CCJP CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	6803084632	MI

General Provider Information

NPI Number	:	1366425407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE A KOZLOW RSWT CPS CCJP CADC

Provider Business Mailing Address
First Line	:	PO BOX 40
Second Line	:
City	:	NATIONAL CITY
State	:	MI
Zip	:	48748-0040
Country	:	US
Telephone Number	:	989-240-7464
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 E STATE ST
Second Line	:
City	:	STERLING
State	:	MI
Zip	:	48659-9548
Country	:	US
Telephone Number	:	989-654-3501
Fax Number	:	989-524-3788

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	05/22/2012

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