Healthcare Provider Details

I. General information

NPI: 1336788785
Provider Name (Legal Business Name): JAIME KOWIESKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SW ALASKA ST
SEATTLE WA
98126-2731
US

IV. Provider business mailing address

3151 ALKI AVE SW APT 29
SEATTLE WA
98116-2663
US

V. Phone/Fax

Practice location:
  • Phone: 847-271-7966
  • Fax:
Mailing address:
  • Phone: 847-271-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60890440
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: