Individual
ELIZABETH L KOZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LBA
Contact information
Practice address
600 BOGLE ST STE 2, SOMERSET, KY 42503-2885
(606) 254-0495
Mailing address
340 LAKE FOREST DR, SOMERSET, KY 42503-6381
(606) 425-2324
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
240343
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100572880
—
KY
Enumeration date
09/24/2018
Last updated
04/08/2019
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