Provider Demographics
NPI:1508945213
Name:KOZLOWSKI, MARLENE ANN (ACSW LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:ANN
Last Name:KOZLOWSKI
Suffix:
Gender:F
Credentials:ACSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5639 SASHABAW RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3149
Mailing Address - Country:US
Mailing Address - Phone:586-247-3699
Mailing Address - Fax:
Practice Address - Street 1:5639 SASHABAW RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3149
Practice Address - Country:US
Practice Address - Phone:586-247-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010680021041C0700X
MI4101006144106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008965400OtherBCBS
MI8008965400OtherBCBS
MI0N53770Medicare ID - Type Unspecified