Provider Demographics
NPI:1659420065
Name:KOWIESKI, ELIZABETH JEAN (MS LCPC CADC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JEAN
Last Name:KOWIESKI
Suffix:
Gender:F
Credentials:MS LCPC CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 ELA RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047
Mailing Address - Country:US
Mailing Address - Phone:847-550-0395
Mailing Address - Fax:847-550-9780
Practice Address - Street 1:755 ELA RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-550-0395
Practice Address - Fax:847-550-9780
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5839101YA0400X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004930264OtherBCBS OF IL PIN