Provider Demographics
NPI:1861409930
Name:KOZY-LANDRESS, KAREN EILEEN (MED, MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:EILEEN
Last Name:KOZY-LANDRESS
Suffix:
Gender:F
Credentials:MED, MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 GEORGE EDWARDS CT
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4458
Mailing Address - Country:US
Mailing Address - Phone:321-537-8762
Mailing Address - Fax:321-452-0134
Practice Address - Street 1:1327 GEORGE EDWARDS CT
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4458
Practice Address - Country:US
Practice Address - Phone:321-537-8762
Practice Address - Fax:321-452-0134
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA-5827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL830045300Medicaid