Healthcare Provider Details

I. General information

NPI: 1770106130
Provider Name (Legal Business Name): KELLY NEDELYA KOWALCHUK LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 07/26/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CAMPUS BLVD SUITE 100
NEWTOWN SQUARE PA
19073
US

IV. Provider business mailing address

1724 BARKER CIR
WEST CHESTER PA
19380-6188
US

V. Phone/Fax

Practice location:
  • Phone: 610-585-6522
  • Fax:
Mailing address:
  • Phone: 610-585-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: