1730353442 NPI number — MS. MARY SUSAN KOWALSKI PTA,CLT

Table of content: MS. MARY SUSAN KOWALSKI PTA,CLT (NPI 1730353442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730353442 NPI number — MS. MARY SUSAN KOWALSKI PTA,CLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOWALSKI
Provider First Name:
MARY
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PTA,CLT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730353442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 ROUND LAKE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE CANADA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55117-6014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-484-8480
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 SMITH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102-2344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-241-7288
Provider Business Practice Location Address Fax Number:
651-241-7177
Provider Enumeration Date:
04/15/2008

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: 225200000X , with the licence number:  JULY 2008 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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