MEDICARE: DR. MICHAEL KOZLOWSKI PH.D.

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	3588	OR
2	103T00000X	Psychologist	3405	OR

General Provider Information

NPI Number	:	1770864688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL KOZLOWSKI PH.D.

Provider Business Mailing Address
First Line	:	619 MADISON ST STE 108
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2354
Country	:	US
Telephone Number	:	503-303-4257
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 MADISON ST STE 108
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2354
Country	:	US
Telephone Number	:	503-303-4257
Fax Number	:

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

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/03/2022

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