Healthcare Provider Details

I. General information

NPI: 1659420065
Provider Name (Legal Business Name): ELIZABETH JEAN KOWIESKI MS LCPC CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 ELA RD SUITE 1A
LAKE ZURICH IL
60047
US

IV. Provider business mailing address

755 ELA RD SUITE 1A
LAKE ZURICH IL
60047
US

V. Phone/Fax

Practice location:
  • Phone: 847-550-0395
  • Fax: 847-550-9780
Mailing address:
  • Phone: 847-550-0395
  • Fax: 847-550-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5839
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: