Provider Demographics
NPI:1679210868
Name:ROZOK, KATTY MATILDE (LCSW)
Entity type:Individual
Prefix:
First Name:KATTY
Middle Name:MATILDE
Last Name:ROZOK
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N 1ST AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1451
Mailing Address - Country:US
Mailing Address - Phone:208-626-9638
Mailing Address - Fax:
Practice Address - Street 1:212 N 1ST AVE STE 202
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1451
Practice Address - Country:US
Practice Address - Phone:208-626-9638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID88617371041C0700X, 1041C0700X
IDLMSW-412671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical