Healthcare Provider Details

I. General information

NPI: 1053028969
Provider Name (Legal Business Name): KATHERINE KOWALAK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6241 BERKINSHAW DR
CINCINNATI OH
45230-3663
US

IV. Provider business mailing address

6241 BERKINSHAW DR
CINCINNATI OH
45230-3663
US

V. Phone/Fax

Practice location:
  • Phone: 513-708-7114
  • Fax:
Mailing address:
  • Phone: 513-708-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0006818-SUPV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0032555
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: