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General NPI Number Information
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NPI Number | 1386025344
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Entity Type | Individual
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Provider Name | COURTNEY LYNNE KOWALCZYK PHD, LLP
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Gender | Female
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 3355 EAGLE PARK DR NE STE 109
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-7004
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Country | US
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Telephone | 616-773-1478
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Fax | 616-773-1473
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Provider Business Mailing Address
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Address Line | 3355 EAGLE PARK DR NE STE 109
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-7004
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Country | US
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Telephone | 616-773-1478
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Fax | 616-773-1473
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301015496
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License Number State | MI
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