Provider Demographics
NPI:1346062635
Name:KOWALSKI, LETITIA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:LETITIA
Middle Name:MARIE
Last Name:KOWALSKI
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-5100
Mailing Address - Country:US
Mailing Address - Phone:217-972-9721
Mailing Address - Fax:
Practice Address - Street 1:27475 FERRY RD
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3808
Practice Address - Country:US
Practice Address - Phone:630-699-7254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.114811104100000X
IL149.0288961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker