Healthcare Provider Details

I. General information

NPI: 1982271748
Provider Name (Legal Business Name): JESSICA KOWALSKI MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15930 19 MILE RD STE 150
CLINTON TOWNSHIP MI
48038-1155
US

IV. Provider business mailing address

15930 19 MILE RD STE 150
CLINTON TOWNSHIP MI
48038-1155
US

V. Phone/Fax

Practice location:
  • Phone: 586-281-5866
  • Fax:
Mailing address:
  • Phone: 586-281-5866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401224967
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: