Healthcare Provider Details

I. General information

NPI: 1861899775
Provider Name (Legal Business Name): CHAD KOWALSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E MAIN ST
REEDSBURG WI
53959-1940
US

IV. Provider business mailing address

348 E MAIN ST
REEDSBURG WI
53959-1940
US

V. Phone/Fax

Practice location:
  • Phone: 608-843-3229
  • Fax: 608-768-0816
Mailing address:
  • Phone: 608-843-3229
  • Fax: 608-768-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1924-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: