Provider Demographics
NPI:1831450642
Name:KOWALIK, BRITTANY ALEXIS (MS, DT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ALEXIS
Last Name:KOWALIK
Suffix:
Gender:F
Credentials:MS, DT
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:ALEXIS
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1200 W MONROE ST APT 313
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2555
Mailing Address - Country:US
Mailing Address - Phone:440-320-3569
Mailing Address - Fax:
Practice Address - Street 1:1200 W MONROE ST APT 313
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2555
Practice Address - Country:US
Practice Address - Phone:440-320-3569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ILBK07940323P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health