Provider Demographics
NPI:1295819597
Name:KOWATSCH, CAROLYN ANN (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:KOWATSCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6127 OASIS CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-6435
Mailing Address - Country:US
Mailing Address - Phone:513-574-8821
Mailing Address - Fax:
Practice Address - Street 1:2300 MONTANA AVE
Practice Address - Street 2:317
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-3829
Practice Address - Country:US
Practice Address - Phone:513-662-8200
Practice Address - Fax:513-662-8201
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2150103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKOCP02363Medicare ID - Type Unspecified