Provider Demographics
NPI:1285117002
Name:KOWALSKY, SUSANNE
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:KOWALSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:MARIE
Other - Last Name:BERNERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5025 N KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2624
Mailing Address - Country:US
Mailing Address - Phone:773-343-7096
Mailing Address - Fax:
Practice Address - Street 1:5025 N KILBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2624
Practice Address - Country:US
Practice Address - Phone:773-343-7096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional