Basic Information
| Provider Information | |||||||||
| NPI: | 1629374236 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COZAD | ||||||||
| FirstName: | IVONNE | ||||||||
| MiddleName: | NATALIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 SW FRAZIER AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852325005 | ||||||||
| FaxNumber: | 7852320160 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 SW FRAZIER AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852325005 | ||||||||
| FaxNumber: | 7852320160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2011 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
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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 | 103T00000X | 2616 | KS | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | 1493 | KS | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.