Healthcare Provider Details

I. General information

NPI: 1205292018
Provider Name (Legal Business Name): NICOLAI JOSEPH KOWALSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33464 SCHOENHERR RD
STERLING HEIGHTS MI
48312-6314
US

IV. Provider business mailing address

23475 TALBOT ST
CLINTON TWP MI
48035-4356
US

V. Phone/Fax

Practice location:
  • Phone: 586-879-5707
  • Fax:
Mailing address:
  • Phone: 586-879-5707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401-001044
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: