Healthcare Provider Details

I. General information

NPI: 1003242603
Provider Name (Legal Business Name): LAURA E KOWALSKI LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 12/06/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 E MAIN ST STE 405
SAINT CHARLES IL
60174-2296
US

IV. Provider business mailing address

1121 E MAIN ST STE 405
SAINT CHARLES IL
60174-2296
US

V. Phone/Fax

Practice location:
  • Phone: 630-344-9623
  • Fax: 331-422-3230
Mailing address:
  • Phone: 630-344-9623
  • Fax: 331-422-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number180 008166
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180008166
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: