Healthcare Provider Details

I. General information

NPI: 1831450642
Provider Name (Legal Business Name): BRITTANY ALEXIS KOWALIK MS, DT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY ALEXIS MARTIN MS

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 04/24/2023
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W MONROE ST APT 313
CHICAGO IL
60607-2555
US

IV. Provider business mailing address

1200 W MONROE ST APT 313
CHICAGO IL
60607-2555
US

V. Phone/Fax

Practice location:
  • Phone: 440-320-3569
  • Fax:
Mailing address:
  • Phone: 440-320-3569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberBK07940323P
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: