Healthcare Provider Details

I. General information

NPI: 1174437016
Provider Name (Legal Business Name): MICHAELA KOWALYK MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WALNUT ST
WELLESLEY MA
02481-2118
US

IV. Provider business mailing address

9 WHIPPLETREE RD
CHELMSFORD MA
01824-1929
US

V. Phone/Fax

Practice location:
  • Phone: 781-489-3697
  • Fax:
Mailing address:
  • Phone: 978-886-7995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP101951
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: