Healthcare Provider Details

I. General information

NPI: 1770137234
Provider Name (Legal Business Name): PATRICIA KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27777 INKSTER RD SUITE 100
FARMINGTON HILLS MI
48334
US

IV. Provider business mailing address

27777 INKSTER RD SUITE 100
FARMINGTON HILLS MI
48334
US

V. Phone/Fax

Practice location:
  • Phone: 248-436-4400
  • Fax:
Mailing address:
  • Phone: 248-436-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: