Healthcare Provider Details

I. General information

NPI: 1851913156
Provider Name (Legal Business Name): GAIL ROBIN KOWALKOWSKI APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N 8TH ST
SHEBOYGAN WI
53081-4006
US

IV. Provider business mailing address

1011 N 8TH ST
SHEBOYGAN WI
53081-4006
US

V. Phone/Fax

Practice location:
  • Phone: 920-459-0360
  • Fax: 920-459-4353
Mailing address:
  • Phone: 920-459-0360
  • Fax: 920-459-4353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number130655-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: