Provider Demographics
NPI:1912448614
Name:KOZICKI-BONNERT, KAMILA (MHS-CCC/SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:KAMILA
Middle Name:
Last Name:KOZICKI-BONNERT
Suffix:
Gender:F
Credentials:MHS-CCC/SLP/L
Other - Prefix:MS
Other - First Name:KAMILA
Other - Middle Name:
Other - Last Name:KOZICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:888 N MERRILL ST
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-2746
Mailing Address - Country:US
Mailing Address - Phone:847-778-6985
Mailing Address - Fax:
Practice Address - Street 1:888 N MERRILL ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-2746
Practice Address - Country:US
Practice Address - Phone:847-778-6985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist