Healthcare Provider Details

I. General information

NPI: 1346062635
Provider Name (Legal Business Name): LETITIA MARIE KOWALSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27475 FERRY RD
WARRENVILLE IL
60555-3808
US

IV. Provider business mailing address

1196 PARKSIDE DR
SUGAR GROVE IL
60554-5100
US

V. Phone/Fax

Practice location:
  • Phone: 630-699-7254
  • Fax:
Mailing address:
  • Phone: 217-972-9721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.114811
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.028896
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: