Provider Demographics
NPI:1659002525
Name:KOZUSZEK, EMILY GRACE (MGC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE
Last Name:KOZUSZEK
Suffix:
Gender:F
Credentials:MGC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:GRACE
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 ROCK HAVEN RD APT E202
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-5551
Mailing Address - Country:US
Mailing Address - Phone:630-551-6207
Mailing Address - Fax:
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-816-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS