Provider Demographics
NPI:1447377023
Name:KOZIOL PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:KOZIOL PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZIOL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-686-3643
Mailing Address - Street 1:PO BOX 1457
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60078-1457
Mailing Address - Country:US
Mailing Address - Phone:847-686-3643
Mailing Address - Fax:
Practice Address - Street 1:3800 N WILKE RD
Practice Address - Street 2:SUITE 160
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1278
Practice Address - Country:US
Practice Address - Phone:847-686-3643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04672011OtherBLUE SHIELD
IL932500Medicare ID - Type Unspecified