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General NPI Number Information
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NPI Number | 1205532108
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Entity Type | Individual
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Provider Name | NICOLE B KOWALCZYK LCPC
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Gender | Female
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 33 OAK BLUFF TER
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City | UTICA
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State | IL
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Zip | 61373-9509
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Country | US
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Telephone | 815-780-0769
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Fax |
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Provider Business Mailing Address
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Address Line | 33 OAK BLUFF TER
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City | UTICA
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State | IL
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Zip | 61373-9509
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.012824
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License Number State | IL
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