Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180008166 | IL |
N | 1041C0700X | Clinical Social Worker | 180 008166 | IL |
NPI | 1003242603 |
---|---|
Provider Name | Laura E Kowalski |
First Address | Saint Charles, IL 60174-2296 |
Second Address | Saint Charles, IL 60174-2296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2013 |
Last Update Date | 06/12/2021 |