Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | SW127005 | PA |
NPI | 1003110057 |
---|---|
Provider Name | Michele Koziel |
First Address | Wilkes Barre, PA 18711-0030 |
Second Address | Wilkes Barre, PA 18711-0030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2011 |
Last Update Date | 08/09/2011 |