Provider Demographics
NPI:1730503608
Name:KOZLOWSKI, MELISSA MARIE (LCPC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MARIE
Last Name:KOZLOWSKI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 COMMERCE STREET
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:815-531-4104
Mailing Address - Fax:815-722-4390
Practice Address - Street 1:115 CAMPBELL ST STE 203
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2777
Practice Address - Country:US
Practice Address - Phone:815-531-4104
Practice Address - Fax:815-722-4390
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008869101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216521Medicare PIN