Provider Demographics
NPI:1821585464
Name:KOZAK, KASEY MORGAN (RBT)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:MORGAN
Last Name:KOZAK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 W HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-1088
Mailing Address - Country:US
Mailing Address - Phone:912-996-2391
Mailing Address - Fax:
Practice Address - Street 1:747 W HILLCREST RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-1088
Practice Address - Country:US
Practice Address - Phone:912-996-2391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18-53497106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician