Provider Demographics
NPI:1649341165
Name:EVA B KOZLOVSKY MS PC
Entity type:Organization
Organization Name:EVA B KOZLOVSKY MS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:KOZLOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:972-722-1919
Mailing Address - Street 1:2546 E FM 552
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8384
Mailing Address - Country:US
Mailing Address - Phone:972-722-1919
Mailing Address - Fax:972-771-1919
Practice Address - Street 1:2546 E FM 552
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8384
Practice Address - Country:US
Practice Address - Phone:972-722-1919
Practice Address - Fax:972-771-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty