Provider Demographics
NPI:1821310897
Name:BOZEK, KATIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:BOZEK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 KRAFT AVE SE
Mailing Address - Street 2:SUITE 256
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-7700
Mailing Address - Country:US
Mailing Address - Phone:616-890-0879
Mailing Address - Fax:
Practice Address - Street 1:2828 KRAFT AVE SE
Practice Address - Street 2:SUITE 256
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-7700
Practice Address - Country:US
Practice Address - Phone:616-890-0879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist