Healthcare Provider Details

I. General information

NPI: 1891463279
Provider Name (Legal Business Name): BRITTNEE SUE KOWALEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N WATER ST FL 4
MILWAUKEE WI
53202-2557
US

IV. Provider business mailing address

1562 30TH AVE APT 2A
KENOSHA WI
53144-3218
US

V. Phone/Fax

Practice location:
  • Phone: 262-902-9194
  • Fax:
Mailing address:
  • Phone: 262-902-9194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: