=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154744936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KELLY ANN DOWIAK PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2014
-----------------------------------------------------
Last Update Date | 01/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 WARRENDALE BAYNE RD
-----------------------------------------------------
City | WARRENDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15086-7558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-591-2440
-----------------------------------------------------
Fax | 724-799-8871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 317 PINE WOOD DR
-----------------------------------------------------
City | WEXFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15090-8524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-591-2440
-----------------------------------------------------
Fax | 724-799-8871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | MRS. KELLY ANN DOWIAK
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 724-591-2440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC006942
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------