Healthcare Provider Details

I. General information

NPI: 1336036714
Provider Name (Legal Business Name): ROBERTA ELLEN KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79149 480TH AVE
ASHTON NE
68817-2283
US

IV. Provider business mailing address

79149 480TH AVE
ASHTON NE
68817-2283
US

V. Phone/Fax

Practice location:
  • Phone: 308-750-5438
  • Fax:
Mailing address:
  • Phone: 308-750-5438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: