Healthcare Provider Details

I. General information

NPI: 1710396221
Provider Name (Legal Business Name): KIMBERLY KOWALIK MS, CRC, CCDPD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BUIST RD
MILFORD PA
18337-9311
US

IV. Provider business mailing address

10 BUIST RD P.O. BOX 1195
MILFORD PA
18337-9311
US

V. Phone/Fax

Practice location:
  • Phone: 570-296-1054
  • Fax: 570-296-9227
Mailing address:
  • Phone: 570-296-1054
  • Fax: 570-296-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: