Provider Demographics
NPI:1386025344
Name:KOWALCZYK, COURTNEY LYNNE (PHD, LLP)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LYNNE
Last Name:KOWALCZYK
Suffix:
Gender:F
Credentials:PHD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 EAGLE PARK DR NE STE 109
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7004
Mailing Address - Country:US
Mailing Address - Phone:616-773-1478
Mailing Address - Fax:616-773-1473
Practice Address - Street 1:3355 EAGLE PARK DR NE STE 109
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7004
Practice Address - Country:US
Practice Address - Phone:616-773-1478
Practice Address - Fax:616-773-1473
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015496103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical