Healthcare Provider Details

I. General information

NPI: 1538129036
Provider Name (Legal Business Name): DEBRA ANN KOWALCZYK M.A., LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E NORTHWEST HWY SUITE 212
PALATINE IL
60067-1708
US

IV. Provider business mailing address

1519 N DRYDEN AVE
ARLINGTON HEIGHTS IL
60004-4031
US

V. Phone/Fax

Practice location:
  • Phone: 708-280-6538
  • Fax:
Mailing address:
  • Phone: 847-670-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: