Basic Information
| Provider Information | |||||||||
| NPI: | 1417399650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOZAK | ||||||||
| FirstName: | KATLYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 MACK BLVD | ||||||||
| Address2: | 2ND FL | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181035622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848840183 | ||||||||
| FaxNumber: | 4848840628 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 DEKALB PIKE | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194011820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102782834 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2013 | ||||||||
| LastUpdateDate: | 07/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.