Healthcare Provider Details

I. General information

NPI: 1013646314
Provider Name (Legal Business Name): MARY L KOWALSKI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY DUKE

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1791 ALUM CREEK DR
COLUMBUS OH
43207-1757
US

IV. Provider business mailing address

1488 FAIRVIEW AVE APT A
COLUMBUS OH
43212-2838
US

V. Phone/Fax

Practice location:
  • Phone: 614-445-8131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512012
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: