Provider Demographics
NPI:1689165243
Name:KOWALESKI, KATIE A (AUD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:KOWALESKI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:A
Other - Last Name:OESTREICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-281-4466
Mailing Address - Fax:
Practice Address - Street 1:4600 W LOOMIS RD STE 201
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4858
Practice Address - Country:US
Practice Address - Phone:414-281-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI679-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100086525Medicaid