Provider Demographics
NPI:1063192771
Name:KOWALESKI, DIMITRA SOFIA (AUD)
Entity type:Individual
Prefix:DR
First Name:DIMITRA
Middle Name:SOFIA
Last Name:KOWALESKI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:DIMITRA
Other - Middle Name:SOFIA
Other - Last Name:MIHALOPOULOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:634 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6109
Mailing Address - Country:US
Mailing Address - Phone:469-261-0878
Mailing Address - Fax:
Practice Address - Street 1:4130 ABRAMS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2607
Practice Address - Country:US
Practice Address - Phone:214-827-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81539231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist