Provider Demographics
NPI:1558033787
Name:KOZICZKOWSKI, TRACI (MSW LCSW SAC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:KOZICZKOWSKI
Suffix:
Gender:F
Credentials:MSW LCSW SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DIVISION ST N UNIT 3
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1183
Mailing Address - Country:US
Mailing Address - Phone:715-600-3568
Mailing Address - Fax:
Practice Address - Street 1:101 DIVISION ST N UNIT 3
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1183
Practice Address - Country:US
Practice Address - Phone:715-600-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker