Provider Demographics
NPI:1760778864
Name:KOZLIK, MICHAELA (LCPC)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:KOZLIK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5426
Mailing Address - Country:US
Mailing Address - Phone:630-784-4827
Mailing Address - Fax:
Practice Address - Street 1:222 E WILLOW AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5426
Practice Address - Country:US
Practice Address - Phone:630-784-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006430101YM0800X
IL180008356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health