Provider Demographics
NPI:1508074030
Name:KOZLER, SHEILA KAY SR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:KAY
Last Name:KOZLER
Suffix:SR
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3657 COUNTY ROAD A
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-9759
Mailing Address - Country:US
Mailing Address - Phone:920-723-0307
Mailing Address - Fax:
Practice Address - Street 1:1550 MADISON AVE
Practice Address - Street 2:SUITE # 102-104
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-3162
Practice Address - Country:US
Practice Address - Phone:920-723-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2574-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical