Provider Demographics
NPI:1003240656
Name:KOZELL-WINGETT, TERESA BETH
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:BETH
Last Name:KOZELL-WINGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 LOCKHAVEN DR NE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3768
Mailing Address - Country:US
Mailing Address - Phone:971-218-7381
Mailing Address - Fax:
Practice Address - Street 1:784 LOCKHAVEN DR NE
Practice Address - Street 2:BUILDING C
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-3768
Practice Address - Country:US
Practice Address - Phone:971-218-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst