MEDICARE: GINA MICHELE KOZAR

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	101YM0800X	Mental Health Counselor	150117764	IL
2	104100000X	Social Worker	150117764	IL

General Provider Information

NPI Number	:	1699650937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MICHELE KOZAR

Provider Business Mailing Address
First Line	:	5465 GRAND AVE STE 101
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-4913
Country	:	US
Telephone Number	:	224-303-4396
Fax Number	:	224-214-3154

Provider Business Practice Location Address
First Line	:	5465 GRAND AVE STE 101
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-4913
Country	:	US
Telephone Number	:	224-303-4396
Fax Number	:	224-214-3154

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

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	01/21/2026

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Directions to “ GINA MICHELE KOZAR ” Practice Location

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