Provider Demographics
NPI:1215284534
Name:KOWALSKI, JESSICA HELEN (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HELEN
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:HELEN
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29.D STONEHILL ROAD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543
Mailing Address - Country:US
Mailing Address - Phone:630-554-6156
Mailing Address - Fax:630-554-6378
Practice Address - Street 1:29D STONEHILL ROAD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543
Practice Address - Country:US
Practice Address - Phone:630-554-6156
Practice Address - Fax:630-554-6378
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019260225100000X
IL070-019260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist