Provider Demographics
NPI:1013379684
Name:GOZNER, MATT (MA)
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:GOZNER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 HOUBOLT RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8303
Mailing Address - Country:US
Mailing Address - Phone:815-263-8209
Mailing Address - Fax:
Practice Address - Street 1:370 HOUBOLT RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8303
Practice Address - Country:US
Practice Address - Phone:815-263-8209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor