Provider Demographics
NPI:1821783788
Name:KOZIOL, MONICA (EDD; EDS; LMSW)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:KOZIOL
Suffix:
Gender:F
Credentials:EDD; EDS; LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E RANDOLPH ST APT 3105
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7338
Mailing Address - Country:US
Mailing Address - Phone:312-292-7365
Mailing Address - Fax:
Practice Address - Street 1:360 E RANDOLPH ST APT 3105
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7338
Practice Address - Country:US
Practice Address - Phone:312-292-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X, 251S00000X
IL1501090621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty