Provider Demographics
NPI:1922463934
Name:KOZLOVA, SVETLANA (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:KOZLOVA
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-0970
Mailing Address - Country:US
Mailing Address - Phone:864-596-8491
Mailing Address - Fax:864-596-8495
Practice Address - Street 1:698 HOWARD ST
Practice Address - Street 2:SPARTANBURG SCHOOL DISTRICT 7
Practice Address - City:SPARATANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-596-8491
Practice Address - Fax:864-596-8495
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5700OtherSC DEPARTMENT OF LABOR, LICENSING AND REGULATION