Provider Demographics
NPI:1528324027
Name:KOWALSKI, KIMBERLY (BCBA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 DAINA CT
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5420
Mailing Address - Country:US
Mailing Address - Phone:707-834-2621
Mailing Address - Fax:
Practice Address - Street 1:2134 DAINA CT
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5420
Practice Address - Country:US
Practice Address - Phone:707-834-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-8204103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst