Provider Demographics
NPI:1093564064
Name:KOWALKE, KATHLEEN MARY (LPC, CTRS)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:KOWALKE
Suffix:
Gender:F
Credentials:LPC, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 PARKRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1529
Mailing Address - Country:US
Mailing Address - Phone:262-352-4010
Mailing Address - Fax:
Practice Address - Street 1:1825 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2316
Practice Address - Country:US
Practice Address - Phone:920-272-8220
Practice Address - Fax:651-323-2648
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11075-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional