Healthcare Provider Details

I. General information

NPI: 1215685300
Provider Name (Legal Business Name): ERICA KOWALSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 E COLUMBIA ST
TUCSON AZ
85714-3414
US

IV. Provider business mailing address

10333 N ORACLE RD APT 2206
ORO VALLEY AZ
85737-5104
US

V. Phone/Fax

Practice location:
  • Phone: 520-306-0997
  • Fax:
Mailing address:
  • Phone: 520-668-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-18121
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: