MEDICARE: CAROLYN ANN KOWATSCH PH.D.

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	103TC0700X	Clinical Psychologist	2150	OH

General Provider Information

NPI Number	:	1295819597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN ANN KOWATSCH PH.D.

Provider Business Mailing Address
First Line	:	6127 OASIS CT
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-6435
Country	:	US
Telephone Number	:	513-574-8821
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 MONTANA AVE
Second Line	:	317
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3829
Country	:	US
Telephone Number	:	513-662-8200
Fax Number	:	513-662-8201

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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