Healthcare Provider Details

I. General information

NPI: 1598475139
Provider Name (Legal Business Name): KRISTINA KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 WOODWARD AVE STE 2800
DETROIT MI
48202-3157
US

IV. Provider business mailing address

7375 WOODWARD AVE STE 2800
DETROIT MI
48202-3157
US

V. Phone/Fax

Practice location:
  • Phone: 310-710-8744
  • Fax: 855-568-2494
Mailing address:
  • Phone: 313-710-8744
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: