MEDICARE: MRS. JULIE ANN KOWALSKI M.S, CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	011336-1	NY
2	235Z00000X	Speech-Language Pathologist	011336	NY

General Provider Information

NPI Number	:	1255511762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE ANN KOWALSKI M.S, CCC/SLP

Provider Business Mailing Address
First Line	:	6109 WOODFORD DR
Second Line	:
City	:	LAKE VIEW
State	:	NY
Zip	:	14085-9457
Country	:	US
Telephone Number	:	716-335-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	4242 RIDGE LEA RD
Second Line	:	SUITE 2
City	:	AMHERST
State	:	NY
Zip	:	14226-1051
Country	:	US
Telephone Number	:	716-819-2400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	08/30/2012

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