MEDICARE: KYRA JAYNE KOWALEWSKI

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	101YM0800X	Mental Health Counselor	10808	SC

General Provider Information

NPI Number	:	1437005584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYRA JAYNE KOWALEWSKI

Provider Business Mailing Address
First Line	:	887 JOHNNIE DODDS BLVD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 DES ARC RD
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-8334
Country	:	US
Telephone Number	:	484-746-0483
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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