Provider Demographics
NPI:1902577489
Name:BOZZO, JUDITH ANN (MPA/HEALTH CARE)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:BOZZO
Suffix:
Gender:F
Credentials:MPA/HEALTH CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 N. MAGNOLIA AVE
Mailing Address - Street 2:909 N. WASHINGTON AVE.
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3024
Mailing Address - Country:US
Mailing Address - Phone:517-614-4736
Mailing Address - Fax:
Practice Address - Street 1:909 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5137
Practice Address - Country:US
Practice Address - Phone:517-484-5526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI330279101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)