Healthcare Provider Details

I. General information

NPI: 1639093677
Provider Name (Legal Business Name): KATHERINE KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 MORRIS RD
FAIRFIELD TOWNSHIP OH
45011-5120
US

IV. Provider business mailing address

6116 MORRIS RD
FAIRFIELD TOWNSHIP OH
45011-5120
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-0070
  • Fax:
Mailing address:
  • Phone: 513-868-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLSP.00652
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: