Provider Demographics
NPI:1689736050
Name:KOWALSKY, VICKI W (MSN PSYD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:W
Last Name:KOWALSKY
Suffix:
Gender:F
Credentials:MSN PSYD
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:L
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN PSYD
Mailing Address - Street 1:10735 S CICERO AVENUE
Mailing Address - Street 2:208 CENTER FOR PSYCHOLOGICAL SERVICES
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-424-0001
Mailing Address - Fax:708-424-1394
Practice Address - Street 1:10735 S CICERO AVENUE
Practice Address - Street 2:208
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-424-0001
Practice Address - Fax:708-424-1394
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
01623005OtherBCBS CENTER FOR PSYCHOLOG
ILK01718Medicare ID - Type Unspecified