Provider Demographics
NPI:1710396221
Name:KOWALIK, KIMBERLY (MS, CRC, CCDPD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KOWALIK
Suffix:
Gender:F
Credentials:MS, CRC, CCDPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BUIST RD
Mailing Address - Street 2:P.O. BOX 1195
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9311
Mailing Address - Country:US
Mailing Address - Phone:570-296-1054
Mailing Address - Fax:570-296-9227
Practice Address - Street 1:10 BUIST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9311
Practice Address - Country:US
Practice Address - Phone:570-296-1054
Practice Address - Fax:570-296-9227
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007592970029Medicaid