MEDICARE: ANNA MARISSA 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1578967568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA MARISSA KOWALSKI

Provider Business Mailing Address
First Line	:	833 NW 33RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7248
Country	:	US
Telephone Number	:	405-974-0684
Fax Number	:

Provider Business Practice Location Address
First Line	:	833 NW 33RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7248
Country	:	US
Telephone Number	:	405-974-0684
Fax Number	:

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

Provider Enumeration Date	:	10/20/2014
Last Update Date	:	10/20/2014

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Directions to “ ANNA MARISSA KOWALSKI ” Practice Location

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