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NPI Code Detail

MEDICARE: JAIME KOWIESKI

MEDICARE: JAIME KOWIESKI
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
1101YM0800XMental Health CounselorMC60890440WA

General Provider Information

NPI Number : 1336788785
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIME KOWIESKI
Provider Business Mailing Address
First Line : 3151 ALKI AVE SW APT 29
Second Line :
City : SEATTLE
State : WA
Zip : 98116-2663
Country : US
Telephone Number : 847-271-7966
Fax Number :
Provider Business Practice Location Address
First Line : 3500 SW ALASKA ST
Second Line :
City : SEATTLE
State : WA
Zip : 98126-2731
Country : US
Telephone Number : 847-271-7966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2020
Last Update Date : 01/02/2020

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