Provider Information for 1619360617
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
Mrs. IVY REBECCA KOWALSKI LPC
Other Names:Former Name:IVY HUMPHREYSex: Female
NPI: 1619360617
Last Updated: 2022-04-30
Certification Date: 2022-04-30
Certification Date: 2022-04-30
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1619360617 | ||||||||||||
| Enumeration Date | 2015-03-15 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1100 52ND ST SE KENTWOOD, MI 49508-6008 United States Phone: 616-304-3095 | Fax: | ||||||||||||
| Primary Practice Address | 1100 52ND ST SE KENTWOOD, MI 49508-6008 United States Phone: 616-304-3095 | Fax: | ||||||||||||
| Secondary Practice Address(es) | |||||||||||||
| Health Information Exchange |
| ||||||||||||
| Other Identifiers |
| ||||||||||||
| Taxonomy |
|