Provider Demographics
NPI:1700134616
Name:KOZLOVSKY, JEANNE OLINDA (APCSW)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:OLINDA
Last Name:KOZLOVSKY
Suffix:
Gender:F
Credentials:APCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10335 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4634
Mailing Address - Country:US
Mailing Address - Phone:262-853-0468
Mailing Address - Fax:
Practice Address - Street 1:10335 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53225-4634
Practice Address - Country:US
Practice Address - Phone:262-853-0468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127269121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker