Provider Demographics
NPI:1770970477
Name:KOZIK, HEATHER MARLENE (DT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARLENE
Last Name:KOZIK
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARLENE
Other - Last Name:JANIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 GREENLEAF DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436-9724
Mailing Address - Country:US
Mailing Address - Phone:630-669-5299
Mailing Address - Fax:
Practice Address - Street 1:909 GREENLEAF DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436-9724
Practice Address - Country:US
Practice Address - Phone:630-669-5299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist