Healthcare Provider Details

I. General information

NPI: 1063445088
Provider Name (Legal Business Name): JOANNA KOWALIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 W BROWN RD DESERT VITA BEHAVIORAL CENTER
MESA AZ
85201-3227
US

IV. Provider business mailing address

2929 E THOMAS RD
PHOENIX AZ
85016-8034
US

V. Phone/Fax

Practice location:
  • Phone: 480-344-2037
  • Fax: 480-344-2155
Mailing address:
  • Phone: 602-470-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35667
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35667
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: