Healthcare Provider Details

I. General information

NPI: 1043729643
Provider Name (Legal Business Name): JAMES ISADOR KOWALSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9845 W ROOSEVELT RD
WESTCHESTER IL
60154-2758
US

IV. Provider business mailing address

1339 N WICKER PARK AVE APT 4
CHICAGO IL
60622-3109
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-2325
  • Fax:
Mailing address:
  • Phone: 954-593-0667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: