Provider Demographics
NPI:1619267929
Name:KOZIARA, JESSICA SUE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUE
Last Name:KOZIARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:FONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:231 BOBWHITE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-2715
Mailing Address - Country:US
Mailing Address - Phone:517-204-1779
Mailing Address - Fax:
Practice Address - Street 1:293 PLANTATION HILL RD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4861
Practice Address - Country:US
Practice Address - Phone:850-525-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor