Active NPI
Blake Kozlowski
- Clinical Psychologist
- Royal Oak, MI
National Provider Identifier
1053299131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6362009995
- Practice address
- 25600 Woodward Ave Ste 109
Royal Oak, MI 48067-0944 - Phone
- (574) 302-7443
- NPI assigned
- Aug 26, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6362009995 | MI | Primary |
Addresses
Primary practice location
25600 Woodward Ave Ste 109
Royal Oak, MI 48067-0944
Mailing address
346 George St
Trenton, MI 48183-2144
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6362009995 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756166400000",
"number": "1053299131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "346 GEORGE ST",
"city": "TRENTON",
"state": "MI",
"postal_code": "481832144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25600 WOODWARD AVE STE 109",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480670944",
"telephone_number": "574-302-7443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOZLOWSKI",
"first_name": "BLAKE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-08-26",
"last_updated": "2025-08-26",
"certification_date": "2025-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6362009995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Royal Oak, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.