Provider Demographics
NPI:1770106130
Name:KOWALCHUK, KELLY NEDELYA (LSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:NEDELYA
Last Name:KOWALCHUK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 BARKER CIR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-6188
Mailing Address - Country:US
Mailing Address - Phone:610-585-6522
Mailing Address - Fax:
Practice Address - Street 1:18 CAMPUS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073
Practice Address - Country:US
Practice Address - Phone:610-585-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical