Healthcare Provider Details

I. General information

NPI: 1295819597
Provider Name (Legal Business Name): CAROLYN ANN KOWATSCH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MONTANA AVE 317
CINCINNATI OH
45211-3829
US

IV. Provider business mailing address

6127 OASIS CT
CINCINNATI OH
45247-6435
US

V. Phone/Fax

Practice location:
  • Phone: 513-662-8200
  • Fax: 513-662-8201
Mailing address:
  • Phone: 513-574-8821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2150
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: