Healthcare Provider Details

I. General information

NPI: 1659864858
Provider Name (Legal Business Name): ALISON R. KWOLEK MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N WAYNE ST STE 2A
ANGOLA IN
46703-1080
US

IV. Provider business mailing address

2621 E JEFFERSON ST
WARSAW IN
46580-3880
US

V. Phone/Fax

Practice location:
  • Phone: 260-668-8797
  • Fax:
Mailing address:
  • Phone: 574-267-7169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004147A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2505497
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: