Healthcare Provider Details

I. General information

NPI: 1821263609
Provider Name (Legal Business Name): CRYSTAL KOWALSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 W PRATT BLVD
CHICAGO IL
60645-4125
US

IV. Provider business mailing address

3145 W PRATT BLVD
CHICAGO IL
60645-4125
US

V. Phone/Fax

Practice location:
  • Phone: 773-467-3700
  • Fax:
Mailing address:
  • Phone: 773-467-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178-004693
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: