Provider Demographics
NPI:1851502553
Name:KOZLOWSKI, JENNIFER LYNNE (BS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:KOZLOWSKI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:42116 UTAH DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2984
Mailing Address - Country:US
Mailing Address - Phone:586-258-0206
Mailing Address - Fax:586-258-0201
Practice Address - Street 1:12220 E 13 MILE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5000
Practice Address - Country:US
Practice Address - Phone:586-258-0206
Practice Address - Fax:586-258-0201
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health