Provider Demographics
NPI:1073679528
Name:KOWAL, TRACEY B (LSW)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:B
Last Name:KOWAL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-2743
Mailing Address - Country:US
Mailing Address - Phone:724-366-0158
Mailing Address - Fax:724-438-7755
Practice Address - Street 1:341 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2743
Practice Address - Country:US
Practice Address - Phone:724-366-0158
Practice Address - Fax:724-438-7755
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW010780L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker