Healthcare Provider Details

I. General information

NPI: 1033509815
Provider Name (Legal Business Name): MS. EMILIA KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 W HORIZON RIDGE PKWY STE 101
HENDERSON NV
89052-5029
US

IV. Provider business mailing address

9140 W POST RD STE 100
LAS VEGAS NV
89148-2435
US

V. Phone/Fax

Practice location:
  • Phone: 702-739-8722
  • Fax:
Mailing address:
  • Phone: 702-405-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI0580
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: