Provider Demographics
NPI:1700470846
Name:KOZLOWSKI, LISBETH M
Entity Type:Individual
Prefix:
First Name:LISBETH
Middle Name:M
Last Name:KOZLOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISBETH
Other - Middle Name:M
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4799
Mailing Address - Country:US
Mailing Address - Phone:888-658-9522
Mailing Address - Fax:262-345-5531
Practice Address - Street 1:510 E BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2119
Practice Address - Country:US
Practice Address - Phone:800-438-1772
Practice Address - Fax:262-345-5562
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician