Provider Demographics
NPI:1932137262
Name:KOZEL, JENNY JANE (PHD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:JANE
Last Name:KOZEL
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 1:1818 W FULTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4377
Mailing Address - Country:US
Mailing Address - Phone:605-348-6500
Mailing Address - Fax:605-341-7409
Practice Address - Street 1:1818 W FULTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4377
Practice Address - Country:US
Practice Address - Phone:605-348-6500
Practice Address - Fax:605-341-7409
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD432103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6551810Medicaid
SD8194Medicare ID - Type Unspecified