Healthcare Provider Details

I. General information

NPI: 1326519281
Provider Name (Legal Business Name): ALEXANDRA KOWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 LAUDERDALE DR
RICHMOND VA
23238-3933
US

IV. Provider business mailing address

5006 CHARING CIR
GLEN ALLEN VA
23059-5390
US

V. Phone/Fax

Practice location:
  • Phone: 804-740-2900
  • Fax:
Mailing address:
  • Phone: 804-687-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202009039
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: