Healthcare Provider Details

I. General information

NPI: 1801209481
Provider Name (Legal Business Name): HEATHER KOWALSKI SLP ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17480 DALLAS PKWY
DALLAS TX
75287-7337
US

IV. Provider business mailing address

305 NE LOOP 280; BUSINESS TOWER 1, SUITE 200
HURST TX
76053
US

V. Phone/Fax

Practice location:
  • Phone: 214-623-5900
  • Fax:
Mailing address:
  • Phone: 817-789-6849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number34064
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: