MEDICARE: JENNIFER KOZLOWSKI PIETRZAK LCSW

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	4104-C	NV

General Provider Information

NPI Number	:	1699854331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KOZLOWSKI PIETRZAK LCSW

Provider Business Mailing Address
First Line	:	1070 W HORIZON RIDGE PKWY STE 210
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-6020
Country	:	US
Telephone Number	:	702-219-7597
Fax Number	:	702-939-5237

Provider Business Practice Location Address
First Line	:	1070 W HORIZON RIDGE PKWY STE 210
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-6020
Country	:	US
Telephone Number	:	702-219-7597
Fax Number	:	702-441-0906

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	11/01/2024

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