Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003483579 |
---|---|
Provider Name | Anita Kozak |
First Address | Aurora, IL 60506-5185 |
Second Address | Aurora, IL 60506-5185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2021 |
Last Update Date | 04/06/2021 |