MEDICARE: MS. KERRIE LYNN KOZLOFF

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	101YP2500X	Professional Counselor	6401008882	MI

General Provider Information

NPI Number	:	1750392072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERRIE LYNN KOZLOFF

Provider Business Mailing Address
First Line	:	1011 MILITARY ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-5416
Country	:	US
Telephone Number	:	810-966-3580
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 MILITARY ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-5416
Country	:	US
Telephone Number	:	810-966-3580
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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