Healthcare Provider Details

I. General information

NPI: 1891994919
Provider Name (Legal Business Name): KATHLEEN MARIE KOWALSKI L.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10680 WALES RD
ERIE PA
16510-6810
US

IV. Provider business mailing address

10680 WALES RD
ERIE PA
16510-6810
US

V. Phone/Fax

Practice location:
  • Phone: 814-739-2634
  • Fax:
Mailing address:
  • Phone: 814-725-5025
  • Fax: 814-725-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW 124227
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: