Provider Demographics
NPI:1457997405
Name:KOWALKOWSKA, KLAUDIA
Entity Type:Individual
Prefix:
First Name:KLAUDIA
Middle Name:
Last Name:KOWALKOWSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 N ARLINGTON HEIGHTS RD UNIT 124
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-3184
Mailing Address - Country:US
Mailing Address - Phone:630-890-8824
Mailing Address - Fax:
Practice Address - Street 1:2032 CARL MEARES RD
Practice Address - Street 2:
Practice Address - City:FAIR BLUFF
Practice Address - State:NC
Practice Address - Zip Code:28439-9787
Practice Address - Country:US
Practice Address - Phone:813-763-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-19-86778106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician