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General NPI Number Information
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NPI Number | 1679757710
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Entity Type | Individual
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Provider Name | JENNIFER L. KOWALSKI
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Gender | Female
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 12/26/2007
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Provider Practice Location Address
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Address Line | 3200 WESTHILL DR SUITE 100
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City | WAUSAU
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State | WI
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Zip | 54401-4705
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Country | US
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Telephone | 715-847-2827
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Fax |
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Provider Business Mailing Address
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Address Line | 148 HAHN LN
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City | MOSINEE
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State | WI
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Zip | 54455-8253
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 14860-024
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License Number State | WI
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