Provider Demographics
NPI:1366425407
Name:KOZLOW, JULIE A (RSWT CPS CCJP CADC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:KOZLOW
Suffix:
Gender:F
Credentials:RSWT CPS CCJP CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48748-0040
Mailing Address - Country:US
Mailing Address - Phone:989-240-7464
Mailing Address - Fax:
Practice Address - Street 1:725 E STATE ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MI
Practice Address - Zip Code:48659-9548
Practice Address - Country:US
Practice Address - Phone:989-654-3501
Practice Address - Fax:989-524-3788
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803084632101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)