Healthcare Provider Details

I. General information

NPI: 1053968735
Provider Name (Legal Business Name): LINDSAY KOWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ROUTE 168 STE 103
TURNERSVILLE NJ
08012-3200
US

IV. Provider business mailing address

PO BOX 30
GRENLOCH NJ
08032-0030
US

V. Phone/Fax

Practice location:
  • Phone: 856-266-4983
  • Fax:
Mailing address:
  • Phone: 856-266-4983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00499500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: