MEDICARE: NICOLAI JOSEPH KOWALSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	7401-001044	MI

General Provider Information

NPI Number	:	1205292018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLAI JOSEPH KOWALSKI

Provider Business Mailing Address
First Line	:	23475 TALBOT ST
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-4356
Country	:	US
Telephone Number	:	586-879-5707
Fax Number	:

Provider Business Practice Location Address
First Line	:	33464 SCHOENHERR RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-6314
Country	:	US
Telephone Number	:	586-879-5707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2016
Last Update Date	:	01/26/2026

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