Healthcare Provider Details

I. General information

NPI: 1083003776
Provider Name (Legal Business Name): RACHEL KOWALIK PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 PERUQUE CROSSING CT
O FALLON MO
63366-2362
US

IV. Provider business mailing address

1031 PERUQUE CROSSING CT
O FALLON MO
63366-2362
US

V. Phone/Fax

Practice location:
  • Phone: 636-887-3655
  • Fax: 636-887-3655
Mailing address:
  • Phone: 636-887-3655
  • Fax: 636-887-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: