Healthcare Provider Details

I. General information

NPI: 1467943159
Provider Name (Legal Business Name): KALIE JOY KOWALSKI M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 11/14/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9314 CEDAR LN
BETHESDA MD
20814-3935
US

IV. Provider business mailing address

9314 CEDAR LN
BETHESDA MD
20814-3935
US

V. Phone/Fax

Practice location:
  • Phone: 202-763-0753
  • Fax:
Mailing address:
  • Phone: 202-763-0753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: