Healthcare Provider Details

I. General information

NPI: 1336971654
Provider Name (Legal Business Name): KENZIE CHRISTINE KOWALSKI M.S., SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 SARASOTA DR
AUSTIN TX
78749-3141
US

IV. Provider business mailing address

4413 SARASOTA DR
AUSTIN TX
78749-3141
US

V. Phone/Fax

Practice location:
  • Phone: 817-308-7252
  • Fax:
Mailing address:
  • Phone: 817-308-7252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number121817
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: