Healthcare Provider Details

I. General information

NPI: 1508939620
Provider Name (Legal Business Name): JACQUELINE LOUISE KOWALSKI ED D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 PURCELL AVENUE
CINCINNATI OH
45205-2344
US

IV. Provider business mailing address

712 PURCELL AVENUE
CINCINNATI OH
45205-2344
US

V. Phone/Fax

Practice location:
  • Phone: 513-471-9169
  • Fax: 513-251-7922
Mailing address:
  • Phone: 513-471-9169
  • Fax: 513-251-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3521
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: