Healthcare Provider Details

I. General information

NPI: 1205245537
Provider Name (Legal Business Name): LESLIE R KOWALSKI PHD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 JEFFERS RD
PLAINSBORO NJ
08536-1901
US

IV. Provider business mailing address

7 JEFFERS RD
PLAINSBORO NJ
08536-1901
US

V. Phone/Fax

Practice location:
  • Phone: 908-715-5454
  • Fax:
Mailing address:
  • Phone: 908-715-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-25205
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: