Provider Demographics
NPI:1699650937
Name:KOZAR, GINA MICHELE
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MICHELE
Last Name:KOZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5465 GRAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4913
Mailing Address - Country:US
Mailing Address - Phone:224-303-4396
Mailing Address - Fax:224-214-3154
Practice Address - Street 1:5465 GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4913
Practice Address - Country:US
Practice Address - Phone:224-303-4396
Practice Address - Fax:224-214-3154
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health