Healthcare Provider Details

I. General information

NPI: 1679682488
Provider Name (Legal Business Name): DINA RAE KOWALSKI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 COLLEGE WAY
FERGUS FALLS MN
56537-1060
US

IV. Provider business mailing address

1112 NODAK DR S
FARGO ND
58103-2333
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-6224
  • Fax: 701-232-4687
Mailing address:
  • Phone: 701-232-6224
  • Fax: 701-232-4687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: