1689736050 NPI number — DR. VICKI W KOWALSKY MSN PSYD

Table of content: DR. VICKI W KOWALSKY MSN PSYD (NPI 1689736050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689736050 NPI number — DR. VICKI W KOWALSKY MSN PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOWALSKY
Provider First Name:
VICKI
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MSN PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
VICTORIA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN PSYD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1689736050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10735 S CICERO AVENUE
Provider Second Line Business Mailing Address:
208 CENTER FOR PSYCHOLOGICAL SERVICES
Provider Business Mailing Address City Name:
OAK LAWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-424-0001
Provider Business Mailing Address Fax Number:
708-424-1394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10735 S CICERO AVENUE
Provider Second Line Business Practice Location Address:
208
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-424-0001
Provider Business Practice Location Address Fax Number:
708-424-1394
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01623005 . This is a "BCBS CENTER FOR PSYCHOLOG" identifier . This identifiers is of the category "OTHER".




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