Healthcare Provider Details

I. General information

NPI: 1689997587
Provider Name (Legal Business Name): JANET MARING KOWALSKI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 113TH AVE NE STE 210
KIRKLAND WA
98034-6950
US

IV. Provider business mailing address

216 107TH PL SE
BELLEVUE WA
98004-6296
US

V. Phone/Fax

Practice location:
  • Phone: 425-777-5524
  • Fax: 844-284-8621
Mailing address:
  • Phone: 415-306-2503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 15817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: