Provider Demographics
NPI:1447286653
Name:KOZIOL, RAYMOND J (PHD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:J
Last Name:KOZIOL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TOWER DR
Mailing Address - Street 2:DEAN MEDICAL CENTER
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1239
Mailing Address - Country:US
Mailing Address - Phone:608-825-3008
Mailing Address - Fax:608-825-3794
Practice Address - Street 1:10 TOWER DR
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1239
Practice Address - Country:US
Practice Address - Phone:608-825-3008
Practice Address - Fax:608-825-3794
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1850-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39752600Medicaid
WI4729OtherDEAN HEALTH INSURANCE
WI4729OtherDEAN HEALTH INSURANCE
WI39752600Medicaid