Provider Demographics
NPI:1487999082
Name:KOWALIK, ELIZABETH SUSAN RAY (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUSAN RAY
Last Name:KOWALIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SUSAN RAY
Other - Last Name:KOWALIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ELIZABETH SUSAN RAY
Mailing Address - Street 1:12977 N 40 DR STE 309
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8654
Mailing Address - Country:US
Mailing Address - Phone:314-246-0528
Mailing Address - Fax:
Practice Address - Street 1:12977 N 40 DR STE 309
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8654
Practice Address - Country:US
Practice Address - Phone:314-246-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490242181041C0700X
MO20180362221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical