Provider Demographics
NPI:1477675320
Name:KOWALSKY, SUSAN BETH (ND)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BETH
Last Name:KOWALSKY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 851
Mailing Address - Street 2:16 BEAVER MEADOW ROAD
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-0851
Mailing Address - Country:US
Mailing Address - Phone:802-649-1064
Mailing Address - Fax:
Practice Address - Street 1:16 BEAVER MEADOW ROAD
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-0851
Practice Address - Country:US
Practice Address - Phone:802-649-1064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099-0000016175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath